title: Description and Results of a Comprehensive Care Protocol for Overnight-Stay Spine Surgery in Adults.
abstract: METHODS
  This is a prospective cohort study.
  
  
  OBJECTIVE
  The aim of this study was to define the probability of successful morning-after discharge after adult spine surgery achieved with a standard care protocol as applied to patients with a large variety of common degenerative spine disorders.
  
  
  BACKGROUND
  Qualifying criteria for ambulatory or overnight-stay adult spine surgery are not well defined in either the spine or anesthesia literature. Most reports simply go to American Society of Anesthesiology risk classification or surgical technique alternatives and do not present a clearly defined patient care and case management protocol.
  
  
  METHODS
  A standardized protocol of patient preparation, preoperative comorbidities optimization, and perioperative care was applied in a prospective cohort of 126 patients including 83 lumbar and 41 cervical procedures. Office and hospital chart records were reviewed for relevant outcomes.
  
  
  RESULTS
  Fully 122 of 124 appropriately selected cases were able to successfully achieve uneventful same-day discharge without any need for readmission, unscheduled early emergency room or clinic visits, or other major complications. Both failures were for urinary retention in senior males and resolved after a single-day admission to the main hospital.
  
  
  CONCLUSIONS
  A wide variety of common degenerative spinal pathology in adults can be routinely and safely managed on an overnight-stay basis without requirement for formal hospital inpatient admission in patients appropriately selected and pre-educated to the experience and whose major comorbidities are preoperatively optimized.
  
  
  METHODS
  N/A.
authors.affiliation: Department of Surgery, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Drew A
authors.initials: DA
authors.lastname: Bednar
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000556:Ambulatory Surgical Procedures / Q000592:standards*; D002170:Canada; D002985:Clinical Protocols / Q000592:standards*; D003191:Comprehensive Health Care / Q000458:organization & administration* / Q000592:standards*; D019299:Decompression, Surgical; D017586:Diskectomy; D005260:Female; D006801:Humans; D065406:Laminoplasty; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013122:Spinal Diseases / Q000601:surgery*; D013123:Spinal Fusion; D013131:Spine / Q000601:surgery; D055815:Young Adult