National Trends in Outpatient Surgical Treatment of Degenerative Cervical Spine Disease
11 October 2013
24 April 2014
14 July 2014 (eFirst)
Study Design Retrospective population-based observational study.
Objective To assess the growth of cervical spine surgery performed in an outpatient setting.
Methods A retrospective study was conducted using the United States Healthcare Cost and Utilization Project's State Inpatient and Ambulatory Surgery Databases for California, New York, Florida, and Maryland from 2005 to 2009. Current Procedural Terminology, fourth revision (CPT-4) and International Classification of Diseases, ninth revision Clinical Modification (ICD-9-CM) codes were used to identify operations for degenerative cervical spine diseases in adults (age > 20 years). Disposition and complication rates were examined.
Results There was an increase in cervical spine surgeries performed in an ambulatory setting during the study period. Anterior cervical diskectomy and fusion accounted for 68% of outpatient procedures; posterior decompression made up 21%. Younger patients predominantly underwent anterior fusion procedures, and patients in the eighth and ninth decades of life had more posterior decompressions. Charlson comorbidity index and complication rates were substantially lower for ambulatory cases when compared with inpatients. The majority (>99%) of patients were discharged home following ambulatory surgery.
Conclusions Recently, the number of cervical spine surgeries has increased in general, and more of these procedures are being performed in an ambulatory setting. The majority (>99%) of patients are discharged home but the nature of analyzing administrative data limits accurate assessment of postoperative complications and thus patient safety. This increase in outpatient cervical spine surgery necessitates further discussion of its safety.
- 1 Rathore MA, Andrabi SI, Mansha M, Brown MG. Day case laparoscopic cholecystectomy is safe and feasible: a case controlled study. Int J Surg 2007; 5 (4) 255-259
- 2 Kim S, Bosque J, Meehan JP, Jamali A, Marder R. Increase in outpatient knee arthroscopy in the United States: a comparison of National Surveys of Ambulatory Surgery, 1996 and 2006. J Bone Joint Surg Am 2011; 93 (11) 994-1000
- 3 Gray DT, Deyo RA, Kreuter W , et al. Population-based trends in volumes and rates of ambulatory lumbar spine surgery. Spine (Phila Pa 1976) 2006; 31 (17) 1957-1963 , discussion 1964
- 4 Wang MC, Kreuter W, Wolfla CE, Maiman DJ, Deyo RA. Trends and variations in cervical spine surgery in the United States: Medicare beneficiaries, 1992 to 2005. Spine (Phila Pa 1976) 2009; 34 (9) 955-961 , discussion 962–963
- 5 Lad SP, Patil CG, Berta S, Santarelli JG, Ho C, Boakye M. National trends in spinal fusion for cervical spondylotic myelopathy. Surg Neurol 2009; 71 (1) 66-69 , discussion 69
- 6 Stieber JR, Brown K, Donald GD, Cohen JD. Anterior cervical decompression and fusion with plate fixation as an outpatient procedure. Spine J 2005; 5 (5) 503-507
- 7 Lied B, Sundseth J, Helseth E. Immediate (0-6 h), early (6-72 h) and late (>72 h) complications after anterior cervical discectomy with fusion for cervical disc degeneration; discharge six hours after operation is feasible. Acta Neurochir (Wien) 2008; 150 (2) 111-118 , discussion 118
- 8 Liu JT, Briner RP, Friedman JA. Comparison of inpatient vs. outpatient anterior cervical discectomy and fusion: a retrospective case series. BMC Surg 2009; 9: 3
- 9 Garringer SM, Sasso RC. Safety of anterior cervical discectomy and fusion performed as outpatient surgery. J Spinal Disord Tech 2010; 23 (7) 439-443
- 10 Trahan J, Abramova MV, Richter EO, Steck JC. Feasibility of anterior cervical discectomy and fusion as an outpatient procedure. World Neurosurg 2011; 75 (1) 145-148 , discussion 43–44
- 11 Suk KS, Kim KT, Lee SH, Park SW. Prevertebral soft tissue swelling after anterior cervical discectomy and fusion with plate fixation. Int Orthop 2006; 30 (4) 290-294
- 12 Sagi HC, Beutler W, Carroll E, Connolly PJ. Airway complications associated with surgery on the anterior cervical spine. Spine (Phila Pa 1976) 2002; 27 (9) 949-953
- 13 Healthcare Cost and Utilization Project state inpatient and ambulatory surgery databases. Available at: http://www.hcup-us.ahrq.gov/ . Accessed October 2011
- 14 Wang MC, Chan L, Maiman DJ, Kreuter W, Deyo RA. Complications and mortality associated with cervical spine surgery for degenerative disease in the United States. Spine (Phila Pa 1976) 2007; 32 (3) 342-347
- 15 Friedman AL, Cheung K, Roman SA, Sosa JA. Early clinical and economic outcomes of patients undergoing living donor nephrectomy in the United States. Arch Surg 2010; 145 (4) 356-362 , discussion 362
- 16 Fry DE, Pine M, Jones BL, Meimban RJ. Comparative effectiveness and efficiency in peripheral vascular surgery. Am J Surg 2011; 201 (3) 363-367 , discussion 367–368
- 17 Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 1987; 40 (5) 373-383
- 18 Deyo RA, Cherkin DC, Ciol MA. Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases. J Clin Epidemiol 1992; 45 (6) 613-619
- 19 Marawar S, Girardi FP, Sama AA , et al. National trends in anterior cervical fusion procedures. Spine (Phila Pa 1976) 2010; 35 (15) 1454-1459
- 20 Silvers HR, Lewis PJ, Suddaby LS, Asch HL, Clabeaux DE, Blumenson LE. Day surgery for cervical microdiscectomy: is it safe and effective?. J Spinal Disord 1996; 9 (4) 287-293
- 21 Angevine PD, Arons RR, McCormick PC. National and regional rates and variation of cervical discectomy with and without anterior fusion, 1990-1999. Spine (Phila Pa 1976) 2003; 28 (9) 931-939 , discussion 940
- 22 Chassin MR. Explaining geographic variations. The enthusiasm hypothesis. Med Care 1993; 31 (5, Suppl): YS37-YS44
- 23 Lurie JD, Birkmeyer NJ, Weinstein JN. Rates of advanced spinal imaging and spine surgery. Spine (Phila Pa 1976) 2003; 28 (6) 616-620
- 24 Fountas KN, Kapsalaki EZ, Nikolakakos LG , et al. Anterior cervical discectomy and fusion associated complications. Spine (Phila Pa 1976) 2007; 32 (21) 2310-2317
- 25 Emery SE, Smith MD, Bohlman HH. Upper-airway obstruction after multilevel cervical corpectomy for myelopathy. J Bone Joint Surg Am 1991; 73 (4) 544-551
- 26 Epstein NE, Hollingsworth R, Nardi D, Singer J. Can airway complications following multilevel anterior cervical surgery be avoided?. J Neurosurg 2001; 94 (2, Suppl): 185-188