title: Thirty-Day Morbidity After Single-Level Anterior Cervical Discectomy and Fusion: Identification of Risk Factors and Emphasis on the Safety of Outpatient Procedures.
abstract: BACKGROUND
  Risk factors for complication after single-level anterior cervical discectomy and fusion remain poorly defined. The purpose of this study was to identify the incidence and risk factors for complication from a large, prospectively collected database, with a separate emphasis on the safety of outpatient procedures.
  
  
  METHODS
  The American College of Surgeons National Surgical Quality Improvement Program prospectively collects thirty-day morbidity and mortality data from more than 480 hospitals around the United States. We retrospectively queried this database to identify cases of single-level elective anterior cervical discectomy and fusion. Univariate and multivariate analyses were used to identify risk factors for complication, and a propensity score model was used to create matched inpatient and outpatient cohorts.
  
  
  RESULTS
  Of 2914 cases identified, 597 (20.5%) received outpatient treatment and 2317 (79.5%) received inpatient treatment. The overall incidence of any systemic morbidity was 3.2%. There were five mortalities (0.2%), four in the inpatient cohort and one in the outpatient cohort. Patient age over sixty-five years, body mass index of >30 kg/m2, American Society of Anesthesiologists class of 3 or 4, current dialysis, current corticosteroid use, recent sepsis, and operative times longer than 120 minutes were each independent risk factors for complication in the multivariate analysis. After propensity score matching to control for comorbidities, there were no significant differences in complication rates between inpatients and outpatients, and outpatient treatment was not a risk factor for complication in the multivariate analysis.
  
  
  CONCLUSIONS
  Single-level elective anterior cervical discectomy and fusion had low complication rates, with no additional risk seen with outpatient as compared with inpatient procedures. It seems reasonable to consider inpatient admission for any patient with the risk factors identified here, particularly difficult airways. This information may be useful to surgeons performing informed consents for medical optimization and for selecting patients most appropriate for outpatient treatment.
  
  
  METHODS
  Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
authors.affiliation: Department of Orthopaedic Surgery and Rehabilitation, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, 01008 JPP, Iowa City, IA 52242. E-mail address for C.T. Martin: Christopher-T-Martin@uiowa.edu. E-mail address for A.J. Pugely: Andrew-Pugely@uiowa.edu. E-mail address for Y. Gao: Yubo-Gao@uiowa.edu. E-mail address for S. Mendoza-Lattes: Sergio-Mendoza@uiowa.edu.
authors.forename: Christopher T
authors.initials: CT
authors.lastname: Martin
authors.affiliation: Department of Orthopaedic Surgery and Rehabilitation, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, 01008 JPP, Iowa City, IA 52242. E-mail address for C.T. Martin: Christopher-T-Martin@uiowa.edu. E-mail address for A.J. Pugely: Andrew-Pugely@uiowa.edu. E-mail address for Y. Gao: Yubo-Gao@uiowa.edu. E-mail address for S. Mendoza-Lattes: Sergio-Mendoza@uiowa.edu.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Pugely
authors.affiliation: Department of Orthopaedic Surgery and Rehabilitation, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, 01008 JPP, Iowa City, IA 52242. E-mail address for C.T. Martin: Christopher-T-Martin@uiowa.edu. E-mail address for A.J. Pugely: Andrew-Pugely@uiowa.edu. E-mail address for Y. Gao: Yubo-Gao@uiowa.edu. E-mail address for S. Mendoza-Lattes: Sergio-Mendoza@uiowa.edu.
authors.forename: Yubo
authors.initials: Y
authors.lastname: Gao
authors.affiliation: Department of Orthopaedic Surgery and Rehabilitation, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, 01008 JPP, Iowa City, IA 52242. E-mail address for C.T. Martin: Christopher-T-Martin@uiowa.edu. E-mail address for A.J. Pugely: Andrew-Pugely@uiowa.edu. E-mail address for Y. Gao: Yubo-Gao@uiowa.edu. E-mail address for S. Mendoza-Lattes: Sergio-Mendoza@uiowa.edu.
authors.forename: Sergio
authors.initials: S
authors.lastname: Mendoza-Lattes
mesh_terms: D000556:Ambulatory Surgical Procedures; D002574:Cervical Vertebrae / Q000601:surgery*; D017586:Diskectomy / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006760:Hospitalization; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D061214:Patient Safety; D011183:Postoperative Complications / Q000453:epidemiology*; D057216:Propensity Score; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013123:Spinal Fusion / Q000009:adverse effects / Q000379:methods*; D013997:Time Factors; D014481:United States