title: National trends in outpatient surgical treatment of degenerative cervical spine disease.
abstract: Study Design Retrospective population-based observational study. Objective To assess the growth of cervical spine surgery performed in an outpatient setting. Methods A retrospective study was conducted using the United States Healthcare Cost and Utilization Project's State Inpatient and Ambulatory Surgery Databases for California, New York, Florida, and Maryland from 2005 to 2009. Current Procedural Terminology, fourth revision (CPT-4) and International Classification of Diseases, ninth revision Clinical Modification (ICD-9-CM) codes were used to identify operations for degenerative cervical spine diseases in adults (age > 20 years). Disposition and complication rates were examined. Results There was an increase in cervical spine surgeries performed in an ambulatory setting during the study period. Anterior cervical diskectomy and fusion accounted for 68% of outpatient procedures; posterior decompression made up 21%. Younger patients predominantly underwent anterior fusion procedures, and patients in the eighth and ninth decades of life had more posterior decompressions. Charlson comorbidity index and complication rates were substantially lower for ambulatory cases when compared with inpatients. The majority (>99%) of patients were discharged home following ambulatory surgery. Conclusions Recently, the number of cervical spine surgeries has increased in general, and more of these procedures are being performed in an ambulatory setting. The majority (>99%) of patients are discharged home but the nature of analyzing administrative data limits accurate assessment of postoperative complications and thus patient safety. This increase in outpatient cervical spine surgery necessitates further discussion of its safety.
authors.affiliation: Department of Orthopaedic Surgery, The Mount Sinai Hospital, New York, New York, United States.
authors.forename: Evan O
authors.initials: EO
authors.lastname: Baird
authors.affiliation: Department of Health Evidence and Policy, The Mount Sinai Hospital, New York, New York, United States.
authors.forename: Natalia N
authors.initials: NN
authors.lastname: Egorova
authors.affiliation: Department of Orthopaedic Surgery, The Mount Sinai Hospital, New York, New York, United States.
authors.forename: Steven J
authors.initials: SJ
authors.lastname: McAnany
authors.affiliation: Department of Orthopaedic Surgery, The Mount Sinai Hospital, New York, New York, United States.
authors.forename: Sheeraz A
authors.initials: SA
authors.lastname: Qureshi
authors.affiliation: Department of Orthopaedic Surgery, The Mount Sinai Hospital, New York, New York, United States.
authors.forename: Andrew C
authors.initials: AC
authors.lastname: Hecht
authors.affiliation: Department of Orthopaedic Surgery, The Mount Sinai Hospital, New York, New York, United States.
authors.forename: Samuel K
authors.initials: SK
authors.lastname: Cho
keywords: ambulatory surgery; cervical spine surgery; complications; safety
references.citation: Arch Surg. 2010 Apr;145(4):356-62; discussion 362
references.pmid: 20404286
references.citation: World Neurosurg. 2011 Jan;75(1):145-8; discussion 43-4
references.pmid: 21492679
references.citation: J Clin Epidemiol. 1992 Jun;45(6):613-9
references.pmid: 1607900
references.citation: Int Orthop. 2006 Aug;30(4):290-4
references.pmid: 16521012
references.citation: Spine (Phila Pa 1976). 2003 May 1;28(9):931-9; discussion 940
references.pmid: 12942010
references.citation: Med Care. 1993 May;31(5 Suppl):YS37-44
references.pmid: 8492584
references.citation: Spine (Phila Pa 1976). 2010 Jul 1;35(15):1454-9
references.pmid: 20216341
references.citation: Int J Surg. 2007 Aug;5(4):255-9
references.pmid: 17660133
references.citation: Spine (Phila Pa 1976). 2002 May 1;27(9):949-53
references.pmid: 11979168
references.citation: BMC Surg. 2009 Mar 05;9:3
references.pmid: 19265540
references.citation: J Bone Joint Surg Am. 2011 Jun 1;93(11):994-1000
references.pmid: 21531866
references.citation: Spine (Phila Pa 1976). 2006 Aug 1;31(17):1957-63; discussion 1964
references.pmid: 16924213
references.citation: Spine J. 2005 Sep-Oct;5(5):503-7
references.pmid: 16153576
references.citation: Am J Surg. 2011 Mar;201(3):363-7; discussion 367-8
references.pmid: 21367380
references.citation: Acta Neurochir (Wien). 2008 Feb;150(2):111-8; discussion 118
references.pmid: 18066487
references.citation: Spine (Phila Pa 1976). 2007 Feb 1;32(3):342-7
references.pmid: 17268266
references.citation: J Chronic Dis. 1987;40(5):373-83
references.pmid: 3558716
references.citation: J Spinal Disord. 1996 Aug;9(4):287-93
references.pmid: 8877954
references.citation: J Spinal Disord Tech. 2010 Oct;23(7):439-43
references.pmid: 20087224
references.citation: J Bone Joint Surg Am. 1991 Apr;73(4):544-51
references.pmid: 2013593
references.citation: J Neurosurg. 2001 Apr;94(2 Suppl):185-8
references.pmid: 11302618
references.citation: Spine (Phila Pa 1976). 2009 Apr 20;34(9):955-61; discussion 962-3
references.pmid: 19352223
references.citation: Spine (Phila Pa 1976). 2007 Oct 1;32(21):2310-7
references.pmid: 17906571
references.citation: Spine (Phila Pa 1976). 2003 Mar 15;28(6):616-20
references.pmid: 12642771
references.citation: Surg Neurol. 2009 Jan;71(1):66-9; discussion 69
references.pmid: 18514286