Friday, September 28, 2018 10:30 AM–12:00 PM abstracts: complications of cervical spine surgery: 155. Same day discharge after anterior cervical discectomy and fusion in suitable patients has similarly low readmission rates as admitted patients

Abstract

BACKGROUND CONTEXT Outpatient ACDFs are being performed at an increasing rate and prior studies have shown similar complication and readmission rates when compared to traditional admission. However, the ideal patient for same day ACDF has yet to be identified. A multidisciplinary group at a tertiary academic center developed a protocol for patient selection and discharge for patients undergoing same day discharge ACDF with the aim of ensuring patient safety and reducing the likelihood of readmission. PURPOSE Our aim was to show that utilizing a standardized protocol to select patients for outpatient ACDF will result in a noninferior readmission rate compared to traditional overnight admission. STUDY DESIGN/SETTING Retrospective review of a prospectively implemented protocol. PATIENT SAMPLE A total of 434 patients undergoing one or two-level ACDF from March 2016 to March 2017 at a tertiary academic institution. OUTCOME MEASURES A total of 30 and 90 day readmission rates. METHODS A retrospective chart-review was performed to identify patients undergoing one or two level primary ACDF who were eligible for same day discharge (SDD) according to the institutional protocol. Patients undergoing cervical disc replacement, three or more level surgery, corpectomy, posterior or revision surgery were excluded. All patients underwent ACDF via the anterior approach with implants based on surgeon preference. Patients with identical surgery and discharge dates were grouped as SDD and admitted patients were grouped as same day admission (SDA). Using our electronic health record's analytics, readmissions in the 90-day postoperative period were identified. RESULTS A total of 434 patients underwent one or two level ACDF from March 2016 to March 2017 of which 126 patients were SDD and 308 were SDA. Due to the protocol, baseline characteristics such as age, operative time and time in the recovery room was significantly different between the two groups. In each group there was one readmission during the 30 day postoperative period and the SDA group had one additional readmission in the 90 day postoperative period. This resulted in an overall, noninferior readmission rate of 0.8% in the SDD group and 0.6% in the SDA group (p=.86). CONCLUSIONS Proper identification of patients suitable for outpatient ACDF using our protocol for patient selection and discharge results in a noninferior readmission rate.