PT  - JOURNAL ARTICLE
AU  - GORNET, MATTHEW F.
AU  - BUTTERMANN, GLENN R.
AU  - WOHNS, RICHARD
AU  - BILLINGHURST, JASON
AU  - BRETT, DARRELL C.
AU  - KUBE, RICHARD
AU  - SALES, J. RAFE
AU  - WILLS, NICHOLAS J.
AU  - SHERBAN, ROSS
AU  - SCHRANCK, FRANCINE W.
AU  - COPAY, ANNE G.
TI  - Safety and Efficiency of Cervical Disc Arthroplasty in Ambulatory Surgery Centers vs. Hospital Settings
AID  - 10.14444/5068
DP  - 2018 Oct 01
TA  - International Journal of Spine Surgery
PG  - 557--564
VI  - 12
IP  - 5
4099  - https://www.ijssurgery.com/content/12/5/557.short
4100  - https://www.ijssurgery.com/content/12/5/557.full
SO  - Int J Spine Surg2018 Oct 01; 12
AB  - Background: Outpatient surgery has been shown safe and effective for anterior cervical discectomy and fusion (ACDF), and more recently, for 1-level cervical disc arthroplasty (CDA). The purpose of this analysis is to compare the safety and efficiency of 1-level and 2-level CDA performed in an ambulatory surgery center (ASC) and in a hospital setting.Methods: The study was a retrospective collection and analysis of data from consecutive CDA patients treated in ASCs compared to a historical control group of patients treated in hospital settings who were classified as outpatient (0 or 1-night stay) or inpatient (2 or more nights). Surgery time, blood loss, return to work, adverse events (AEs), and subsequent surgeries were compared.Results: The sample consisted of 145 ASC patients, 348 hospital outpatients, and 65 hospital inpatients. A greater proportion of 2-level surgeries were performed in hospital than ASC. Surgery times were significantly shorter in ASCs than outpatient or inpatient 1-level (63.6 ± 21.6, 86.5 ± 35.8, and 116.7 ± 48.4 minutes, respectively) and 2-level (92.4 ± 37.3, 126.7 ± 43.8, and 140.3 ± 54.5 minutes, respectively) surgeries. Estimated blood loss was also significantly less in ASC than outpatient and inpatient 1-level (18.5 ± 30.6, 43.7 ± 35.9, and 85.7 ± 98.0 mL, respectively) and 2-level (21.1 ± 12.3, 67.8 ± 94.9, and 64.9 ± 66.1 mL). There were no hospital admissions and no subsequent surgeries among ASC patients. ASC patients had 1 AE (0.7%) and hospital patients had 10 AEs (2.4%). Working patients returned to work after a similar number of days off, but fewer ASC patients had returned to work by the end of the 90-day period.Conclusions: Both 1- and 2-level CDA may be performed safely in an ASC. Surgeries in ASCs are of shorter duration and performed with less blood loss without increased AEs.