title: Postanesthesia care unit imaging is unnecessary when intraoperative imaging is used during anterior cervical decompression and fusion procedures.
abstract: METHODS
  Retrospective case series.
  
  
  OBJECTIVE
  To characterize the clinical utility of imaging in the postanesthesia care unit (PACU) after anterior cervical decompression and fusion (ACDF) procedures.
  
  
  BACKGROUND
  Two sets of imaging are often taken at the end of ACDF procedures: one intraoperatively and the other in the PACU. The latter may have low clinical utility.
  
  
  METHODS
  One hundred four patients who underwent ACDF procedures with anterior plate/screw constructs were identified. A panel assessed intraoperative and PACU series for adequacy of images to detect potential issues with placement of the surgical construct and for any actual visible issues with placement of the surgical construct.
  
  
  RESULTS
  Intraoperative series were adequate to detect potential issues with construct placement for 78.8% of cases, whereas PACU series were adequate for only 58.7% of cases (significant difference, P<0.001). For both series, nearly all inadequacies were because of the shoulders obstructing the lateral view. Accordingly, cases with lower inferior operative levels were much more likely to have inadequate intraoperative and PACU series than cases with higher inferior operative levels (significant differences, P<0.001 for both). In no case was an issue with construct placement visible on a PACU series that was not also visible on an intraoperative series.
  
  
  CONCLUSIONS
  This study demonstrates that PACU images are inferior to intraoperative images and offer little or no incremental clinical utility for detecting issues with surgical construct placement after ACDF procedures. PACU imaging after ACDF procedures might be discontinued to realize savings in time, cost, and radiation exposure.
authors.affiliation: Yale School of Medicine, New Haven, CT 06510, USA.
authors.forename: Daniel D
authors.initials: DD
authors.lastname: Bohl
authors.forename: Connor J
authors.initials: CJ
authors.lastname: Telles
authors.forename: Joshua W
authors.initials: JW
authors.lastname: Hustedt
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Blizzard
authors.forename: Erik J
authors.initials: EJ
authors.lastname: Carlson
authors.forename: Jonathan N
authors.initials: JN
authors.lastname: Grauer
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging* / Q000601:surgery*; D019299:Decompression, Surgical / Q000379:methods*; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D011184:Postoperative Period; D012189:Retrospective Studies; D013123:Spinal Fusion / Q000379:methods*