Evaluating Outcomes Following Outpatient Single-Level Cervical Disc Arthroplasty: A Matched Analysis
Clare K. Green, Joyce En-Hua Wang, Wendy Novicoff, Regis Haid, Stephen D. LockeyStudy Design:
Retrospective cohort study.
Objective:
To compare outcomes and health care utilization between cervical disc arthroplasty (CDA) performed in inpatient and outpatient settings.
Summary of Background Data:
The proportion of cervical spine procedures performed in the outpatient setting has grown steadily over the past decade. CDA is now frequently performed in ambulatory surgical centers. Despite this trend, data on outcomes following outpatient CDA remain limited.
Materials and Methods:
A retrospective search of the PearlDiver database identified adult patients who underwent single-level CDA between 2010 and 2022. After stratifying by service location, eligible patients were matched 1:1 in age range, sex, and the Elixhauser Comorbidity Index (ECI) to create inpatient and outpatient cohorts. Outcomes assessed included 90-day postoperative complications, emergency department (ED) visits and inpatient readmission, and day-of-surgery and 90-day global reimbursements. Univariate analysis and multivariate logistic regression were performed. Kaplan-Meier survival with log-rank testing was performed to compare five-year survival to subsequent CDA or cervical reoperation.
Results:
A total of 5937 patients who underwent outpatient CDA were matched with 5937 patients who underwent inpatient CDA. Outpatient procedures were associated with significantly lower rates of postoperative medical and surgical complications, ED visits (
Conclusion:
Outpatient CDA is associated with significantly lower rates of postoperative ED visits, hospital readmissions, and total reimbursements, without an increased risk of postoperative complications. As the number of CDAs performed in the outpatient setting continues to grow, these findings support the safety and reduced health care utilization associated with outpatient CDA in appropriately selected patients and may assist in guiding preoperative counseling and surgical planning.