233. Ambulatory single-level posterior cervical foraminotomy for cervical radiculopathy: a propensity matched analysis of complication rates

Abstract

<h3>BACKGROUND CONTEXT</h3> Single-level posterior cervical foraminotomy (PCF) for cervical radiculopathy is increasingly performed as an ambulatory procedure. Despite this increase, there is a lack of published literature documenting the safety of ambulatory PCF. <h3>PURPOSE</h3> To evaluate for potential differences in 30-day perioperative complications between ambulatory and inpatient single-level PCF. <h3>STUDY DESIGN/SETTING</h3> Retrospective cohort comparison study. <h3>PATIENT SAMPLE</h3> Patients who underwent single-level PCF for cervical radiculopathy from the 2005-2018 National Surgical Quality Improvement Program (NSQIP) registry. <h3>OUTCOME MEASURES</h3> Perioperative complications within 30 days and readmission within 30 days. <h3>METHODS</h3> Patients who underwent single-level PCF for cervical radiculopathy were identified using ICD and CPT codes from the 2005-2018 NSQIP registry, which contains multi-institutional prospectively collected data for the purpose of clinical research. Ambulatory status was defined as discharge home on same day as surgery was performed (length of stay of 0 days). To account for potential selection bias due to nonrandom assignment of patients between the ambulatory and inpatient cohorts, 1:1 matching utilizing a propensity score (a single score calculated from available patient demographic data to match patients between different treatment groups) was performed. Each ambulatory case was matched with one inpatient case by age, gender, body mass index, functional status, ASA, diabetes mellitus type, and hypertension. Rates of 30-day perioperative aggregated and individual complications, such as readmission, thromboembolic events, wound complications, and reoperation between the matched cohorts were then compared using chi-squared and Fisher's exact tests with Bonferroni correction. In addition, reasons for 30-day readmission after ambulatory single-level PCF were characterized. <h3>RESULTS</h3> In total, 795 ambulatory and 1,789 inpatient single-level PCF cases were identified. After matching, there were 795 ambulatory and 795 inpatient cases. Statistical analysis after propensity score matching revealed no significant difference in individual complications including 30-day readmission, thromboembolic events, wound complications, and reoperation, or aggregated complications between ambulatory vs matched inpatient procedures (p>0.004). The most common reasons for 30-day readmission after ambulatory single-level PCF include surgical site infections (46%) and pain control (15%). <h3>CONCLUSIONS</h3> The perioperative outcomes assessed in the current study support the conclusion that single-level PCF for cervical radiculopathy can be performed in the ambulatory setting without increased rates of 30-day perioperative complications or readmissions compared to inpatient procedures. However, careful patient selection should be exercised in order to determine appropriate ambulatory candidates. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.