title: Best Practices for Outpatient Anterior Cervical Surgery: Results From a Delphi Panel.
abstract: METHODS
  Delphi Panel expert panel consensus and narrative literature review.
  
  
  OBJECTIVE
  To obtain expert consensus on best practices for patient selection and perioperative decision making for outpatient anterior cervical surgery (anterior cervical disc fusion (ACDF) and cervical total disc replacement (CTDR)).
  
  
  BACKGROUND
  Spine surgery in ambulatory settings is becoming a preferred option for both patients and providers. The transition from traditional inpatient environments has been enabled by innovation in anesthesia protocols and surgical technique, as well as favorable economics. Studies have demonstrated that anterior cervical surgery (ACDF and CTDR) can be performed safely on an outpatient basis. However, practice guidelines and evidence-based protocols to inform best practices for the safe and efficient performance of these procedures in same-day, ambulatory settings are lacking.
  
  
  METHODS
  A panel of five neurosurgeons, three anesthesiologists, one orthopedic spine surgeon, and a registered nurse was convened to comprise a multidisciplinary expert panel. A three-round modified-Delphi method was used to generate best-practice statements. Predetermined consensus was set at 70% for each best-practice statement.
  
  
  RESULTS
  A total of 94 consensus statements were reviewed by the panel. After three rounds of review, there was consensus for 83 best-practice statements, while 11 statements failed to achieve consensus. All statements within several perioperative categories (and subcategories) achieved consensus, including preoperative assessment (n = 8), home-care/follow-up (n = 2), second-stage recovery (n = 18), provider economics (n = 8), patient education (n = 14), discharge criteria (n = 4), and hypothermia prevention (n = 6).
  
  
  CONCLUSIONS
  This study obtained expert-panel consensus on best practices for patient selection and perioperative decision making for outpatient anterior cervical surgery (ACDF/CTDR). Given a paucity of guidelines and a lack of established care pathways for ACDF/CTDR in same-day, ambulatory settings, results from this study can supplement available evidence in support of local protocol development for providers considering a transition to the outpatient environment.
  
  
  METHODS
  4.
authors.affiliation: DePuy Synthes, Inc., Raynham, MA.
authors.forename: Anita
authors.initials: A
authors.lastname: Mohandas
authors.affiliation: The Spine Clinic of Monterey Bay, Soquel, CA.
authors.forename: Chris
authors.initials: C
authors.lastname: Summa
authors.affiliation: Surgery and Recovery Partners, LLC, Greenville, SC.
authors.forename: W Bradley
authors.initials: WB
authors.lastname: Worthington
authors.affiliation: DePuy Synthes, Inc., Raynham, MA.
authors.forename: Jason
authors.initials: J
authors.lastname: Lerner
authors.affiliation: Departments of Neurosurgery, Orthopaedic Surgery, and Biomedical Engineering, University of Tennessee Health Science Center and Semmes-Murphey Clinic, Memphis, TN.
authors.forename: Kevin T
authors.initials: KT
authors.lastname: Foley
authors.affiliation: Mayfield Brain and Spine and Department of Neurosurgery, University of Cincinnati, Cincinnati, OH.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Bohinski
authors.affiliation: Howell Allen Clinic and Hospital for Specialty Surgery, Nashville, TN.
authors.forename: Gregory B
authors.initials: GB
authors.lastname: Lanford
authors.affiliation: Microsurgical Spine Center, Puyallup, WA.
authors.forename: Carol
authors.initials: C
authors.lastname: Holden
authors.affiliation: NeoSpine, Puyallup, WA.
authors.forename: Richard N W
authors.initials: RNW
authors.lastname: Wohns
mesh_terms: D000556:Ambulatory Surgical Procedures / Q000379:methods*; D002574:Cervical Vertebrae / Q000601:surgery*; D032921:Consensus; D003697:Delphi Technique; D006801:Humans; D010045:Outpatients; D013123:Spinal Fusion / Q000379:methods*; D059145:Total Disc Replacement / Q000379:methods*