COMPARATIVE EFFECTIVENESS OF OUTPATIENT AND INPATIENT CARE FOLLOWING ANTERIOR CERVICAL DISCECTOMY AND FUSION: AN UPDATED SYSTEMATIC REVIEW AND META-ANALYSIS
A.B.W. Nuru-Ahmed, U.T. Abdul-Hanan, M.N. Naabo, Y.N. Mohammed, R.H. BoampongIntroduction
Anterior cervical discectomy and fusion (ACDF) is a widely used surgical approach for treating cervical radiculopathy. While outpatient ACDF has been gaining popularity, its safety remains unclear. This study provides an updated systematic review and meta-analysis comparing the safety of outpatient versus inpatient ACDF.
Methods
A systematic search of PubMed, Embase, and Cochrane databases identified studies published up to February 3, 2025. Data were extracted and analyzed per Cochrane guidelines. Mean differences (MD) and risk ratios (RR) with 95% confidence intervals (CI) were calculated for continuous and dichotomous outcomes. Subgroup analyses were conducted for single-level ACDF, multiple-level ACDF, and 1- to 2-level ACDF.
Results
Out of 218 studies, 16 met inclusion criteria, encompassing 188,776 patients. No significant differences were observed between outpatient and inpatient surgery in cervical pain or disability at 6 weeks (p = 0.18) and 6 months (p = 0.17), neck pain at 6 weeks (p = 0.31) and 6 months (p = 0.42), or arm pain at 6 weeks (p = 0.14). However, outpatient management was associated with lower reoperation (RR 2.50 [1.16, 5.38], p < 0.02, I 2 = 84%), readmission (RR 1.96 [1.57–2.45], p < 0.00001, I 2 = 83%), and complication rates (RR 1.60 [1.30–1.96], p < 0.00001, I 2 = 90%). All subgroup analyses were consistent with the above result except reoperation rate in the multiple-level subgroup which showed no significant difference (p = 0.19).
Conclusion
Outpatient ACDF is safe and feasible in well selected patients. It is associated with lower rates of reoperation, readmission, and complications compared with inpatient surgery.