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Safety of Outpatient Single-level Cervical Total Disc Replacement

A Propensity-Matched Multi-institutional Study

Bovonratwet, Patawut, BS; Fu, Michael C., MD, MHS; Tyagi, Vineet, MD; Ondeck, Nathaniel T., MD, MHS; Albert, Todd J., MD; Grauer, Jonathan N., MD

doi: 10.1097/BRS.0000000000002884

Study Design. A retrospective cohort comparison study.

Objective. The aim of this study was to investigate the perioperative adverse event profile of cervical total disc replacement (CTDR) performed as an outpatient relative to inpatient procedure.

Summary of Background Data. Recent reimbursement changes and a push for safe reductions in hospital stay have resulted in increased interest in performing CTDRs in the outpatient setting. However, there has been a paucity of studies investigating the safety of outpatient CTDR procedures, despite increasing frequency.

Methods. Patients who underwent single-level CTDR were identified in the 2005 to 2016 National Surgical Quality Improvement Program database. Outpatient versus inpatient procedure status was defined by length of stay, with outpatient being less than 1 day. Patient baseline characteristics and comorbidities were compared between the two groups. Propensity score matched comparisons were then performed for 30-day perioperative complications and readmissions between the two cohorts. In addition, perioperative outcomes of outpatient single-level CTDR versus matched outpatient single-level anterior cervical discectomy and fusion (ACDF) cases were compared.

Results. In total, 373 outpatient and 1612 inpatient single-level CTDR procedures were identified. After propensity score matching was performed to control for potential confounders, statistical analysis revealed no significant difference in perioperative complications between outpatient versus matched inpatient CTDR. Notably, the rate of readmissions was not different between the two groups. In addition, there was no difference in rates of perioperative adverse events between outpatient single-level CTDR versus matched outpatient single-level ACDF.

Conclusion. The perioperative outcomes evaluated in the current study support the conclusion that, for appropriately selected patients, single-level CTDR can be safely performed in the outpatient setting without increased rates of 30-day perioperative complications or readmissions compared with inpatient CTDR or outpatient single-level ACDF.

Level of Evidence: 3

There has been growing interest in performing outpatient cervical total disc replacement. Using propensity score-matched analysis, there were no statistical differences in perioperative complications between outpatient and inpatient single-level cervical total disc replacement procedures. In particular, there were no significant differences in the rate of 30-day readmissions.

Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT

Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY.

Address correspondence and reprint requests to Jonathan N. Grauer, MD, Department of Orthopaedics and Rehabilitation, Yale University School of Medicine, 47 College Street, New Haven, CT 06520; E-mail:

Received 5 June, 2018

Revised 21 July, 2018

Accepted 31 August, 2018

The manuscript submitted does not contain information about medical device(s)/drug(s).

Vernon W. Lippard, MD, Student Research Fellowship at Yale University funds were received in support of this work.

Relevant financial activities outside the submitted work: board membership, consultancy, grants, stocks, royalties, expert testimony.

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