Study Confirms Comparable Outcome for Inpatient and Outpatient Cervical Discectomy

If you’ve been experiencing neck pain along with weakness and pain in your arm or hand, you may be suffering from a herniated or degenerated disc in your neck.

If you come to our spine specialty practice for this condition, our cervical spine specialist will initially suggest a conservative approach that includes physical therapy, and possibly medication. Though this works for many patients, for others the most effective option is a surgery called anterior cervical discectomy and fusion, which both removes the disc and then fuses the bones above and below where it had once been.

Though the surgery sounds serious, a recent study has shown that patients undergoing the procedure in an outpatient setting have comparable clinical outcomes as those who have the surgery in the hospital, while enjoying shorter stays and taking fewer narcotics.

The study, which was published in the Journal of Neurosurgery, was conducted by researchers from the Department of Orthopaedic Surgery at the Rush University Medical Center, in Chicago, Illinois.

The group analyzed the outcomes experienced by patients who all had the anterior cervical discectomy and fusion (ACDF) performed by the same surgeon, with an eye to determining what differences existed between those whose procedures were done in a hospital setting versus an ambulatory surgical center.

Factors that were specifically identified for examination included how long each patient stayed in the hospital and what complications (if any) they experienced. The researchers also used special clinical measurements called the Neck Disability Index and the Visual Analog Scale to quantify neck and arm pain both before and after surgery.

Of the 272 patients that were included in the study, 172 had their procedures performed at a hospital and the other 100 patients had their surgeries at an ambulatory surgery center. The patients whose procedures were done in the hospital tended to be older, more likely to be diabetic, and to have other risk factors, while those whose procedures were done in the ambulatory centers were more likely to have Workers’ Compensation insurance. Those whose procedures were done in the hospital were also more likely to need multilevel procedures.

What the researchers found was that those whose operations were performed in the hospital tended to experience greater blood loss. They stayed in the hospital longer (48.3% were discharged within 24 hours and 43% between 24 and 48 hours), and they consumed more narcotics, despite the fact that their pain scores were the same as those of the patients who had their surgeries performed at ambulatory care centers.

There was one ambulatory center patient that had a minor complication — a pretracheal hematoma — that was managed at the center. Eleven total patients experienced dysphagia, which is post-surgical difficulty in swallowing food: 8 of those cases had their surgeries done in the hospital and 3 at the ambulatory center. All patients with these issues were better in a matter of months.

The post-surgical impact of the surgeries were the same for both groups, leading the researchers to conclude that the ACDF procedure can be performed successfully in both an inpatient and an outpatient setting. The choice between the two is best made by the surgeon, who will assess the various risk factors of each patient.

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