P131. Outpatient single-level posterior cervical foraminotomy is associated with lower risk of perioperative complications

Abstract

BACKGROUND CONTEXT Cervical radiculopathy refers to irritation of nerve roots exiting the cervical spine due to degenerative changes of the facet joints or intervertebral discs. Surgical management may include an anterior or posterior approach. Posterior decompression has been favored due to avoidance of anterior neck structure injury, adjacent segment disease and graft subsidence. Since posterior cervical foraminotomy (PCF) is a relatively safe procedure compared to anterior cervical discectomy and fusion, PCF has gained interest in an outpatient setting. PURPOSE To compare the perioperative surgical and medical complications associated with inpatient and outpatient single-level PCF. STUDY DESIGN/SETTING Retrospective database. PATIENT SAMPLE Patients with cervical radiculopathy who had undergone inpatient or outpatient single-level PCF between 2007 to the first quarter of 2016. OUTCOME MEASURES Charlson Comorbidity Index (CCI) was used as a broad measure of comorbidity. Surgical complications included cervical nerve root injury, dural tear, wound complications, infection, dysphagia, cervicalgia, CSF leakage and revision surgery. Medical complications included pulmonary embolism and lower limb deep vein thrombosis, acute myocardial infarction, acute respiratory failure, pneumonia, sepsis and urinary complications. METHODS The Humana subset of the PearlDiver Patient Record Database was queried to identify patients who had undergone inpatient or outpatient single-level PCF using CPT codes. The incidence of perioperative medical and surgical complications was queried for by using relevant ICD-9, ICD-10 and CPT codes. CCI was compared between the two groups using the 2-tailed Student-t test. Multivariate logistic regression analysis, adjusted for age, sex and CCIwas performed to calculate adjusted odds ratios (ORs), 95% confidence interval and significance level for each complication category, with the inpatient cohort treated as the exposed group. RESULTS Throughout the time period, 1,469 and 1,192 patients received inpatient and outpatient single-level PCF, respectively. In both cohorts, the mean age was 65 to 69-year age group. The mean CCIs ± SD of inpatient and outpatient groups were 2.83±3.11 and 1.46±2.21, respectively (P CONCLUSIONS Compared to inpatient single-level PCF, outpatient PCF is associated with a lower risk of perioperative surgical and medical complications, including wound complications, dysphagia, acute respiratory failure, sepsis, urinary tract infection and urinary incontinence. PCF in outpatients is a safe procedure for the treatment of cervical radiculopathy with an appropriate patient selection. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.