Evidence-Based Spine-Care Journal 2014; 05(02): 101-111
DOI: 10.1055/s-0034-1389088
Systematic Review
Georg Thieme Verlag KG Stuttgart · New York

Outpatient Surgery in the Cervical Spine: Is It Safe?

Michael J. Lee1, Iain Kalfas2, Haley Holmer3, Andrea Skelly3
  • 1Orthopedics and Sports Medicine, University of Washington Medical Center, Seattle, Washington, United States
  • 2Center for Spine Health, Cleveland Clinic, Cleveland, Ohio, United States
  • 3Spectrum Research, Inc., Tacoma, Washington, United States
Further Information

Publication History

22 April 2014

07 July 2014

Publication Date:
24 September 2014 (online)

Abstract

Study Design Systematic review.

Study Rationale As the length of stay after cervical spine surgery has decreased substantially, the feasibility and safety of outpatient cervical spine surgery come into question. Although minimal length of stay is a targeted metric for quality and costs for medical centers, the safety of outpatient cervical spine surgery has not been clearly defined.

Objective The objective of this article is to evaluate the safety of inpatient versus outpatient surgery in the cervical spine for adult patients with symptomatic or asymptomatic degenerative disc disease.

Methods A systematic review of the literature was undertaken for articles published through February 19, 2014. Electronic databases and the bibliographies of key articles were searched to identify comparative studies evaluating the safety of inpatient versus outpatient surgery in the cervical spine. Spinal cord stimulation, spinal injections, and diagnostic procedures were excluded. Two independent reviewers assessed the strength of evidence using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system, and disagreements were resolved by consensus.

Results Five studies that met the inclusion criteria were identified. One study reported low risk of hematoma (0% of outpatients and 1.6% of inpatients). Two studies reported on mortality and both reported no deaths in either group following surgery. Dysphagia risks ranged from 0 to 10% of outpatients and 1.6 to 5% of inpatients, and infection risks ranged from 0 to 1% of outpatients and 2 to 2.8% of inpatients. One study reported that no (0) outpatients were readmitted to the hospital due to a complication, compared with four inpatients (7%). The overall strength of evidence was insufficient for all safety outcomes examined.

Conclusion Though the studies in our systematic review did not suggest an increased risk of complication with outpatient cervical spine surgery, the strength of evidence to make a recommendation was insufficient. Further study is needed to more clearly define the role of outpatient cervical spine surgery.

Supplementary Material