Safety and feasibility of outpatient ACDF in an ambulatory setting: A retrospective chart review

Background: Outpatient spinal surgery is becoming increasingly common and in some areas is now the preferred course for certain procedures. Many different procedures, including ACDF, have been examined in the outpatient setting in the past few years but to our knowledge none have included the ambulatory setting. Methods: All ACDF procedures performed during the time frame of the study were included. Charts were pulled and evaluated using the outcome measures. One and two-level ACDF were divided into respective cervical levels and individually analyzed. Results: Single level ACDF comprised 62% (n = 74) of the total surgeries. Single level ACDF patients averaged a total hospital stay time of 4.7 hours, with a maximum total stay time of 8.2 hours and a minimum stay time of 0.8 hours. Two-level ACDF made up 38% (n = 45) of the total surgeries. The average total stay time for two level ACDF was 5.4 hours, with a maximum time of 9.6 hours and a minimum of 3.4 hours. All patients were comparable in age and gender. There were no major operating complications and neither re-admissions nor deaths after discharge. There were two transfers from ambulatory surgical centers to inpatient status for observation only. Conclusions: Outpatient one and two-level ACDF with plate fixation can safely be done on an outpatient ambulatory basis. The data suggest that all subaxial cervical levels can be treated. Patient fusion and satisfaction data were not obtained and thus cannot be commented upon. Clinical relevance: Ambulatory ACDF should be considered as a feasible option for reducing hospital stay as well as the associated healthcare costs. (C) 2013 Published by Elsevier Inc. on behalf of ISASS The International Society for the Advancement of Spine Surgery.