The Safety of Single and Multilevel Cervical Total Disc Replacement in Ambulatory Surgery Centers

Retrospective cohort. Evaluate the safety profile of single- and multilevel cervical artificial disc replacement (ADR) performed in an outpatient setting. As healthcare costs rise, attempts are made to perform an increasing proportion of spine surgery in ambulatory surgery centers (ASCs). ASCs are m...

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Vydané v:Spine (Philadelphia, Pa. 1976) Ročník 45; číslo 8; s. 512
Hlavní autori: Cuéllar, Jason M, Lanman, Todd H, Rasouli, Alexandre
Médium: Journal Article
Jazyk:English
Vydavateľské údaje: United States 15.04.2020
Predmet:
Adult
Ambulatory Surgical Procedures - adverse effects
Ambulatory Surgical Procedures - methods
Cervical Vertebrae - surgery
Cohort Studies
Female
Hospitalization - trends
Humans
Male
Middle Aged
Postoperative Complications - diagnostic imaging
Postoperative Complications - etiology
Retrospective Studies
Total Disc Replacement - adverse effects
Total Disc Replacement - methods
ISSN:1528-1159, 1528-1159
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Abstract Retrospective cohort. Evaluate the safety profile of single- and multilevel cervical artificial disc replacement (ADR) performed in an outpatient setting. As healthcare costs rise, attempts are made to perform an increasing proportion of spine surgery in ambulatory surgery centers (ASCs). ASCs are more efficient, economically and functionally. Few studies have published on the safety profile of multilevel cervical ADR. We have performed an analysis of all consecutive cervical ADR surgeries that we performed in an ASC over a 9-month period, including multilevel and revision surgery. The pre-, intra-, and postoperative data recorded included age, sex, body mass index, tobacco use, and diabetes; level and procedure, operating room time, estimated blood loss (EBL), and complications; and discharge site, occurrence of reoperation, hospital admission, or any medical complication or infection over a 90-day period. A total of 147 patients underwent 231 treated levels: 71 single-level, 76 multilevel: 69 two-level, 6 three-level, and 1 four-level. Average age was 50 ± 10 years; 71 women, 76 men. None of the patients had insulin-dependent diabetes, 4 were current smokers, and 16 were former smokers. Average body mass index was 26.8 ± 4.6 (range 18-40). Average total anesthesia time was 88 minutes (range 39-168 min). Average EBL was 15 mL (range 5-100 mL). Approximately 90.3% of patients were discharged directly home, 9.7% to an aftercare facility. In the 90-day postoperative period there were zero deaths and two hospital admissions (1.4%)-one for medical complication (0.7%) and one for a surgical site infection (0.7%). In this consecutive case series we performed 231 ADRs in 147 patients in the outpatient setting, including multilevel and revision procedures, with 2 minor postoperative complications resulting in hospital unplanned admissions within 90 days. We believe that these procedures are safe to perform in an ASC. An efficient surgical team and careful patient selection criteria are critical in making this possible. 3.
AbstractList Retrospective cohort.STUDY DESIGNRetrospective cohort.Evaluate the safety profile of single- and multilevel cervical artificial disc replacement (ADR) performed in an outpatient setting.OBJECTIVEEvaluate the safety profile of single- and multilevel cervical artificial disc replacement (ADR) performed in an outpatient setting.As healthcare costs rise, attempts are made to perform an increasing proportion of spine surgery in ambulatory surgery centers (ASCs). ASCs are more efficient, economically and functionally. Few studies have published on the safety profile of multilevel cervical ADR.SUMMARY OF BACKGROUND DATAAs healthcare costs rise, attempts are made to perform an increasing proportion of spine surgery in ambulatory surgery centers (ASCs). ASCs are more efficient, economically and functionally. Few studies have published on the safety profile of multilevel cervical ADR.We have performed an analysis of all consecutive cervical ADR surgeries that we performed in an ASC over a 9-month period, including multilevel and revision surgery. The pre-, intra-, and postoperative data recorded included age, sex, body mass index, tobacco use, and diabetes; level and procedure, operating room time, estimated blood loss (EBL), and complications; and discharge site, occurrence of reoperation, hospital admission, or any medical complication or infection over a 90-day period.METHODSWe have performed an analysis of all consecutive cervical ADR surgeries that we performed in an ASC over a 9-month period, including multilevel and revision surgery. The pre-, intra-, and postoperative data recorded included age, sex, body mass index, tobacco use, and diabetes; level and procedure, operating room time, estimated blood loss (EBL), and complications; and discharge site, occurrence of reoperation, hospital admission, or any medical complication or infection over a 90-day period.A total of 147 patients underwent 231 treated levels: 71 single-level, 76 multilevel: 69 two-level, 6 three-level, and 1 four-level. Average age was 50 ± 10 years; 71 women, 76 men. None of the patients had insulin-dependent diabetes, 4 were current smokers, and 16 were former smokers. Average body mass index was 26.8 ± 4.6 (range 18-40). Average total anesthesia time was 88 minutes (range 39-168 min). Average EBL was 15 mL (range 5-100 mL). Approximately 90.3% of patients were discharged directly home, 9.7% to an aftercare facility. In the 90-day postoperative period there were zero deaths and two hospital admissions (1.4%)-one for medical complication (0.7%) and one for a surgical site infection (0.7%).RESULTSA total of 147 patients underwent 231 treated levels: 71 single-level, 76 multilevel: 69 two-level, 6 three-level, and 1 four-level. Average age was 50 ± 10 years; 71 women, 76 men. None of the patients had insulin-dependent diabetes, 4 were current smokers, and 16 were former smokers. Average body mass index was 26.8 ± 4.6 (range 18-40). Average total anesthesia time was 88 minutes (range 39-168 min). Average EBL was 15 mL (range 5-100 mL). Approximately 90.3% of patients were discharged directly home, 9.7% to an aftercare facility. In the 90-day postoperative period there were zero deaths and two hospital admissions (1.4%)-one for medical complication (0.7%) and one for a surgical site infection (0.7%).In this consecutive case series we performed 231 ADRs in 147 patients in the outpatient setting, including multilevel and revision procedures, with 2 minor postoperative complications resulting in hospital unplanned admissions within 90 days. We believe that these procedures are safe to perform in an ASC. An efficient surgical team and careful patient selection criteria are critical in making this possible.CONCLUSIONIn this consecutive case series we performed 231 ADRs in 147 patients in the outpatient setting, including multilevel and revision procedures, with 2 minor postoperative complications resulting in hospital unplanned admissions within 90 days. We believe that these procedures are safe to perform in an ASC. An efficient surgical team and careful patient selection criteria are critical in making this possible.3.LEVEL OF EVIDENCE3.
Retrospective cohort. Evaluate the safety profile of single- and multilevel cervical artificial disc replacement (ADR) performed in an outpatient setting. As healthcare costs rise, attempts are made to perform an increasing proportion of spine surgery in ambulatory surgery centers (ASCs). ASCs are more efficient, economically and functionally. Few studies have published on the safety profile of multilevel cervical ADR. We have performed an analysis of all consecutive cervical ADR surgeries that we performed in an ASC over a 9-month period, including multilevel and revision surgery. The pre-, intra-, and postoperative data recorded included age, sex, body mass index, tobacco use, and diabetes; level and procedure, operating room time, estimated blood loss (EBL), and complications; and discharge site, occurrence of reoperation, hospital admission, or any medical complication or infection over a 90-day period. A total of 147 patients underwent 231 treated levels: 71 single-level, 76 multilevel: 69 two-level, 6 three-level, and 1 four-level. Average age was 50 ± 10 years; 71 women, 76 men. None of the patients had insulin-dependent diabetes, 4 were current smokers, and 16 were former smokers. Average body mass index was 26.8 ± 4.6 (range 18-40). Average total anesthesia time was 88 minutes (range 39-168 min). Average EBL was 15 mL (range 5-100 mL). Approximately 90.3% of patients were discharged directly home, 9.7% to an aftercare facility. In the 90-day postoperative period there were zero deaths and two hospital admissions (1.4%)-one for medical complication (0.7%) and one for a surgical site infection (0.7%). In this consecutive case series we performed 231 ADRs in 147 patients in the outpatient setting, including multilevel and revision procedures, with 2 minor postoperative complications resulting in hospital unplanned admissions within 90 days. We believe that these procedures are safe to perform in an ASC. An efficient surgical team and careful patient selection criteria are critical in making this possible. 3.
Author Rasouli, Alexandre
Cuéllar, Jason M
Lanman, Todd H
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  givenname: Jason M
  surname: Cuéllar
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  organization: Department of Orthopaedic Surgery, Cedars-Sinai Medical Center, Los Angeles, CA
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  givenname: Todd H
  surname: Lanman
  fullname: Lanman, Todd H
  organization: Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, CA
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  givenname: Alexandre
  surname: Rasouli
  fullname: Rasouli, Alexandre
  organization: Department of Orthopaedic Surgery, Cedars-Sinai Medical Center, Los Angeles, CA
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Snippet Retrospective cohort. Evaluate the safety profile of single- and multilevel cervical artificial disc replacement (ADR) performed in an outpatient setting. As...
Retrospective cohort.STUDY DESIGNRetrospective cohort.Evaluate the safety profile of single- and multilevel cervical artificial disc replacement (ADR)...
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SubjectTerms Adult
Ambulatory Surgical Procedures - adverse effects
Ambulatory Surgical Procedures - methods
Cervical Vertebrae - surgery
Cohort Studies
Female
Hospitalization - trends
Humans
Male
Middle Aged
Postoperative Complications - diagnostic imaging
Postoperative Complications - etiology
Retrospective Studies
Total Disc Replacement - adverse effects
Total Disc Replacement - methods
Title The Safety of Single and Multilevel Cervical Total Disc Replacement in Ambulatory Surgery Centers
URI https://www.ncbi.nlm.nih.gov/pubmed/31703051
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