title: Outpatient anterior cervical discectomy and fusion: A meta-analysis.
abstract: Anterior cervical discectomy and fusion (ACDF) performed as an outpatient has become increasingly common for treating cervical spine pathology, largely due to its cost savings compared with inpatient ACDF. Nearly all outpatient ACDF patient reports have originated from single-center studies, with the procedure yet to be addressed via a meta-analysis of the peer-reviewed literature. The Entrez gateway of the PubMed database was used to conduct a comprehensive literature search for articles published in English up to 3/9/16. Data from studies meeting inclusion criteria (minimum of 25 patients, control group of inpatient ACDF patients, non-duplicative data source) was then categorized and assimilated for analysis. Seven studies met inclusion criteria, encompassing a 21-year timespan. Each provided Oxford Center for Evidence-Based Medicine Level 3 evidence. The studies yielded a total of 2448 outpatient ACDF patients; only 125 (5.1%) originated from studies published prior to 2011. Single-level surgery occurred in 63.8% of patients, with 0.5% extending beyond two-level fusions. The overall complication rate was 1.8% (mean follow-up of 141.2days); only 2% of patients required readmission. In conclusion, outpatient ACDF has become increasingly popular, with more than 95% of patients represented by studies published since 2011. Nearly two-thirds of outpatient ACDFs underwent single-level fusion, with virtually none undergoing 3+ level ACDF. Outpatient ACDF is safe, with a low readmission rate and complication rates comparable to those (2-5%) associated with inpatient ACDF. These findings support an argument for increasing ACDFs performed on an outpatient basis in appropriately selected patients.
authors.affiliation: Division of Spine Surgery, Department of Orthopedic Surgery, Hospital for Joint Diseases, NYU Langone Medical Center, 306 East 15th Street, Ground Floor, New York, NY 10003, USA. Electronic address: drwood@post.harvard.edu.
authors.forename: Shearwood
authors.initials: S
authors.lastname: McClelland
authors.affiliation: Division of Spine Surgery, Department of Orthopedic Surgery, Hospital for Joint Diseases, NYU Langone Medical Center, 306 East 15th Street, Ground Floor, New York, NY 10003, USA.
authors.forename: Jon H
authors.initials: JH
authors.lastname: Oren
authors.affiliation: Division of Spine Surgery, Department of Orthopedic Surgery, Hospital for Joint Diseases, NYU Langone Medical Center, 306 East 15th Street, Ground Floor, New York, NY 10003, USA.
authors.forename: Themistocles S
authors.initials: TS
authors.lastname: Protopsaltis
authors.affiliation: Division of Spine Surgery, Department of Orthopedic Surgery, Hospital for Joint Diseases, NYU Langone Medical Center, 306 East 15th Street, Ground Floor, New York, NY 10003, USA.
authors.forename: Peter G
authors.initials: PG
authors.lastname: Passias
mesh_terms: D000556:Ambulatory Surgical Procedures / Q000379:methods*; D017587:Diskectomy, Percutaneous / Q000379:methods*; D006801:Humans; D013123:Spinal Fusion / Q000379:methods*; D016896:Treatment Outcome
keywords: Anterior cervical discectomy and fusion; Meta-analysis; Outcomes; Outpatient