Outpatient and inpatient readmission rates of 3- and 4-level anterior cervical discectomy and fusion surgeries

OBJECTIVE

With the costs related to the United States medical system constantly rising, efforts are being made to turn traditional inpatient procedures into outpatient same-day surgeries. In this study the authors looked at the various comorbidities and perioperative complications and their impact on readmission rates of patients undergoing outpatient versus inpatient 3- and 4-level anterior cervical discectomy and fusion (ACDF).

METHODS

This was a retrospective study of 337 3- and 4- level ACDF procedures in 332 patients (5 patients had both primary and revision surgeries that were included in this total of 337 procedures) between May 2012 and June 2017. In total, 331 procedures were analyzed, as 6 patients were lost to follow-up. Outpatient surgery was performed for 299 procedures (102 4-level procedures and 197 3-level procedures), and inpatient surgery was performed for 32 procedures (11 4-level procedures and 21 3-level procedures). Age, sex, comorbidities, number of fusion levels, pain level, and perioperative complications were compared between both cohorts.

RESULTS

Analysis was performed for 331 3- and 4-level ACDF procedures done at 6 different hospitals. The overall 30-day readmission rate was 1.2% (outpatient 3 [1.0%] vs inpatient 1 [3.1%], p = 0.847). Outpatients had increased readmission risk, with comorbidities of coronary artery disease (OR 1.058, p = 0.039), autoimmune disease (OR 1.142, p = 0.006), diabetes (OR 1.056, p = 0.001), and chronic kidney disease (OR 0.933, p = 0.035). Perioperative complications of delirium (OR 2.709, p < 0.001) and surgical site infection (OR 2.709, p < 0.001) were associated with increased risk of 30-day hospital readmission in outpatients compared to inpatients.

CONCLUSIONS

This study demonstrates the safety and effectiveness of 3- and 4-level ACDF surgery, although various comorbidities and perioperative complications may lead to higher readmission rates. Patient selection for outpatient 3- and 4-level ACDF cases might play a role in the safety of performing these procedures in the ambulatory setting, but further studies are needed to accurately identify which factors are most pertinent for appropriate selection.

Novel minimally invasive technique in the treatment of cubital tunnel syndrome

Background

Cubital tunnel syndrome is the second most common entrapment neuropathy of the upper extremity in the United States. Most cases are idiopathic and symptoms consist of a combination of weakness, pain, and sensory disturbances ranging from paresthesias and dysesthesias to numbness or complete anesthesia. The purpose of this study is to report results of a novel, minimally invasive surgical procedure for cubital tunnel syndrome with comparison to existing interventions including full open or endoscopic approaches.

Methods

A total of 41 consecutive patients underwent the procedure, their ages ranged from ages 36 to 81 with an average age of 60.52±12.18 years. The procedure consists of a 1.0-2.0-cm incision with decompression of the ulnar nerve under direct visualization proximally with Metzenbaum scissors as a dilator for distal decompression. Patients were evaluated for improvements in pain, numbness, paresthesias, weakness, and muscle atrophy and was measured utilizing the Gabel/Amadio scale.

Results

Fifty-three point two percent (n=25) of patients were found to have excellent outcomes, 36.2% (n=17) had good outcomes, 8.5% (n=4) had fair outcomes, and 2.1% (n=1) had poor outcomes as determined by the Gabel/Amadio scale. The greatest improvement in all patients was the reduction in sensory symptoms: pain, numbness, and paresthesia. There were no operative or postoperative complications.

Conclusions

This novel procedure provided symptom relief comparable to the most effective existing techniques without significant complications, and with rapid recovery and minimal scar formation. The authors assert that this technique demonstrates optimal results for patients with relative ease of adoption for surgeons.