Retrospective Cohort Study
To evaluate the safety of 2-level cervical disc replacement (CDR) in the outpatient setting.
Summary of Background Data.
Despite growing interest in CDR, limited data exists evaluating the safety of 2-level CDR in the outpatient setting.
The National Surgical Quality Improvement Program (NSQIP) database was queried for all 2-level ACDF and CDR procedures between 2015–2018. Demographics, comorbidities, and 30-day postoperative complication rates of outpatient 2-level CDR were compared to those of inpatient 2-level CDR and outpatient 2-level ACDF. Radiographic data is not available in the NSQIP.
403 outpatient CDR's were compared to 408 inpatient CDR's and 4134 outpatient ACDF's. Outpatient CDR patients were older and more likely to have pulmonary comorbidities compared to inpatient CDR (p < 0.03). Outpatient CDR patients were less likely to have an ASA class ≥ 2 and have hypertension compared to outpatient ACDF patients (p < 0.0001). Outpatient CDR had a lower 30-day readmission rate (0.5% vs. 2.5%, p = 0.02) and lower 30-day reoperation rate (0% vs. 1%, p = 0.047) compared to inpatient CDR. Outpatient CDR had a lower readmission rate (0.5% vs. 2.1%, p = 0.03) compared to outpatient ACDF but there was no difference in reoperation rates between the two procedures (0% vs. 0.8%, p = 0.07). Outpatient CDR had an overall complication rate of 0.2%, inpatient CDR had a complication rate of 0.9%, and outpatient ACDF had a complication rate of 1.3%. These differences were not significant.
To our knowledge, this is the largest multicenter study examining the safety of 2-level outpatient CDR procedures. Outpatient 2-level CDR was associated with similarly safe outcomes when compared to inpatient 2-level CDR and outpatient 2-level ACDF. This suggests that 2-level cervical disc replacement can be performed safely in the outpatient setting.
Level of Evidence: 3