Outpatient Cervical and Lumbar Spine Surgery is Feasible and Safe

Helseth, Øystein; Lied, Bjarne; Halvorsen, Charlotte Marie; Ekseth, K.; Helseth, Eirik

doi:10.1227/neu.0000000000000746

Cited by 87 publications

(44 citation statements)

References 49 publications

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“…The majority of studies used the more common Tsukayama et al [172] classification system, in which acute (early) infections occur within one month of the index procedure and chronic (late) infections occur more than one month after the index procedure. The pooled average early SSI rate among 14,517 patients was 2.1% (median, 2.6%; range, 0.5%–16.7%) [11,13,20,22,25,32,78,82–84,86,142,147,156,164,167,170,171] compared with 0.8% (median, 0.9%; range, 0.1%–4.7%) for pooled average late SSI rate among 12,238 patients [11,13,54,83,167,171]. In terms of specific types of spine operations, 52 studies evaluated SSI rates among patients who underwent spinal fusion [9,10,14,15,21,24,27,30,33,42,43,46,52,56,58,62,63,68–70,72,75,76,92,103,105,107–109,111,113–115,119,120,123,125,128,133,139,141–144,146,150,151,157,161,162,164,173].…”

Section: Resultsmentioning

confidence: 99%

Burden of Surgical Site Infections Associated with Select Spine Operations and Involvement ofStaphylococcus aureus

Patel¹,

Khoury²,

Girgenti

et al. 2017

Surgical Infections

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Background: Spine operations may be indicated for treatment of diseases including vertebral injuries, degenerative spinal conditions, disk disease, spinal misalignments, or malformations. Surgical site infection (SSI) is a clinically important complication of spine surgery. Staphylococcus aureus, including methicillin-resistant Staphylococcus aureus (MRSA), is a leading cause of post-spinal SSIs.Methods: PubMed and applicable infectious disease conference proceedings were searched to identify relevant published studies. Overall, 343 full-text publications were screened for epidemiologic, mortality, health care resource utilization, and cost data on SSIs associated with specified spine operations.Results: Surgical site infection rates were identified in 161 studies from North America, Europe, and Asia. Pooled average SSI and S. aureus SSI rates for spine surgery were 1.9% (median, 3.3%; range, 0.1%–22.6%) and 1.0% (median, 2.0%; range, 0.02%–10.0%). Pooled average contribution of S. aureus infections to spinal SSIs was 49.3% (median, 50.0%; range, 16.7%–100%). Pooled average proportion of S. aureus SSIs attributable to MRSA was 37.9% (median, 42.5%; range, 0%–100%). Instrumented spinal fusion had the highest pooled average SSI rate (3.8%), followed by spinal decompression (1.8%) and spinal fusion (1.6%). The SSI-related mortality rate among spine surgical patients ranged from 1.1%–2.3% (three studies). All studies comparing SSI and control cohorts reported longer hospital stays for patients with SSIs. Pooled average SSI-associated re-admission rate occurring within 30 d from discharge ranged from 20% to 100% (four studies). Pooled average SSI-related re-operation rate was 67.1% (median, 100%; range, 33.5%–100%). According to two studies reporting direct costs, spine surgical patients incur approximately double the health care costs when they develop an SSI.Conclusions: Available published studies demonstrate a clinically important burden of SSIs related to spine operations and the substantial contribution of S. aureus (including MRSA). Preventive strategies aimed specifically at S. aureus SSIs could reduce health care costs and improve patient outcomes for spine operations.

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Section: Resultsmentioning

confidence: 99%

Burden of Surgical Site Infections Associated with Select Spine Operations and Involvement ofStaphylococcus aureus

Patel¹,

Khoury²,

Girgenti

et al. 2017

Surgical Infections

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“…8,10,22,25,33,47 Helseth et al reported on a series of 1073 consecutive patients undergoing lumbar procedures at a freestanding neurosurgical clinic with a successful discharge rate of 99.8% on the day of surgery. 19 No patients died within 30 days, and the 90-day readmission rate was 1.5%. Nine patients (0.6%) suffered a postoperative hematoma, which was recognized and evacuated postoperatively, and these patients were subsequently discharged the same day.…”

Section: Outcomes Lumbar Laminectomy and Discectomymentioning

confidence: 91%

Outpatient spine surgery: defining the outcomes, value, and barriers to implementation

Pendharkar

Shahin

et al. 2018

Neurosurgical Focus

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Spine surgery is a key target for cost reduction within the United States health care system. One possible strategy involves the transition of inpatient surgeries to the ambulatory setting. Lumbar laminectomy with or without discectomy, lumbar fusion, anterior cervical discectomy and fusion, and cervical disc arthroplasty all represent promising candidates for outpatient surgeries in select populations. In this focused review, the authors clarify the different definitions used in studies describing outpatient spine surgery. They also discuss the body of evidence supporting each of these procedures and summarize the proposed cost savings. Finally, they examine several patient- and surgeon-specific considerations to highlight the barriers in translating outpatient spine surgery into actual practice.

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“…In the current health care climate, surgical practices have shifted toward performing procedures in outpatient facilities in order to maximize efficiency and minimize costs. [19][20][21][22][23][24][25][26][27][28][29] Prior literature has reported the safety and efficacy of ACDF procedures in the outpatient and inpatient settings. 7,[9][10][11][12][13][14][15] Among other concerns, narcotic usage is associated with a significant side-effect profile, including nausea, vomiting, constipation, drowsiness, coughing, difficulty with deep breathing, transient impairment of psychomotor skills, and impaired bowel and bladder function.…”

Section: Discussionmentioning

confidence: 99%

A Comparison of Narcotic Consumption Between Hospital and Ambulatory-Based Surgery Centers Following Anterior Cervical Discectomy and Fusion

et al. 2018

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Background: Several studies have compared outcomes between hospital-based (HBCs) and ambulatory surgery centers (ASCs) following anterior cervical discectomy and fusion (ACDF). However, the association between narcotic consumption and pain in the early postoperative period has not been well characterized. As such, the purpose of this study is to compare pain, narcotic consumption, and length of stay (LOS) between HBC and ASC patients undergoing same-day-discharge following ACDF. Methods: A surgical registry of patients who underwent a primary, 1-or 2-level ACDF during 2013-2015 was reviewed. Patients were stratified by operative location. Differences in demographics were assessed using independentsample t tests and chi-square analysis. The presence of an association between operative location and outcomes was analyzed using Poisson regression with robust error variance or linear regression adjusted for preoperative characteristics. Results: A total of 76 patients were identified, of which 42 and 34 underwent surgery at an HBC or ASC, respectively. The HBC cohort had greater total (P , .001) and hourly (P ¼ .034) narcotic consumption and prolonged LOS (P , .001). Over 90% of ASC patients consumed less than or equal to the 30th percentile (32.0 mg) of oral morphine equivalents (OME), whereas over 57% of HBC patients consumed greater than 32.0 mg OME. The HBC cohort consumed greater average doses of fentanyl and oxycodone (P , .001 for each). Conclusions: This study demonstrates that patients undergoing same-day surgery for primary 1-or 2-level ACDF received more narcotics at HBCs compared to at ASCs. The increased narcotic consumption at HBCs may have resulted in longer LOS; however, this did not impact long-term pain, complications, or clinical outcomes. Clinical Relevance: Patients scheduled to be discharged on postoperative day 0 following ACDF at HBCs may be able to receive fewer narcotics and be discharged sooner without compromising pain control or increasing their risk for complications.

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Outpatient Cervical and Lumbar Spine Surgery is Feasible and Safe

Cited by 87 publications

References 49 publications

Burden of Surgical Site Infections Associated with Select Spine Operations and Involvement ofStaphylococcus aureus

Burden of Surgical Site Infections Associated with Select Spine Operations and Involvement ofStaphylococcus aureus

Outpatient spine surgery: defining the outcomes, value, and barriers to implementation

A Comparison of Narcotic Consumption Between Hospital and Ambulatory-Based Surgery Centers Following Anterior Cervical Discectomy and Fusion

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