Safety of Outpatient Anterior Cervical Discectomy and Fusion: A Systematic Review and Meta-analysis

Abstract

Abstract INTRODUCTION Anterior cervical discectomy and fusion (ACDF) is one of the most prevalent surgical procedures and is used to treat several cervical spinal pathologies, including herniated discs, degenerative disc disease, and spondylosis. With the increasing prevalence of ACDF procedures, this procedure has become an excellent target for clinical optimization. Indeed, in recent years, ACDF has become increasingly offered on an outpatient basis. To date, the incidence and dynamics of perioperative complications and safety surrounding outpatient ACDF remain poorly resolved. METHODS We systematically reviewed the literature for articles published by April 2018 describing outpatient ACDF and associated complications, including incidence of reoperation, stroke, thrombolytic events, dysphagia, hematoma, and mortality. A random-effects analysis was performed comparing overall and specific complications between the inpatient and outpatient ACDF groups. RESULTS We identified 21 articles that satisfied the selection criteria, of which 15 were comparative studies. Most of the existing studies were retrospective, with a lack of level I or II studies on this topic. We found no statistically significant difference between inpatient and outpatient ACDF in overall complications, incidence of stroke, thrombolytic events, dysphagia, and hematoma development. However, patients undergoing outpatient ACDF had lower reported reoperation rates (P < .001), mortality (P < .001), and hospitalization duration (P < .001). CONCLUSION Our meta-analysis indicates that there is a lack of high level of evidence studies regarding the safety of outpatient ACDF. However, the existing literature suggests that outpatient ACDF can be safe, with low complication rates comparable to inpatient ACDF in well-selected patients. Patients with advanced age and comorbidities such as obesity and significant myelopathy are likely not suitable for outpatient ACDF. Spine surgeons must carefully evaluate each patient to decide whether outpatient ACDF is a safe option.