ACDF 30-day morbidity: 5 things to know

Written by Laura Dyrda | August 11, 2014 | Print  |

A study published in the August edition of the Journal of Bone and Joint Surgery examines the 30-day morbidity after single-level anterior cervical discectomy and fusion.

The researchers examined 2,914 cases, with 597 in the outpatient setting. The cases were analyzed from the American College of Surgeons National Surgical Quality Improvement Program that prospectively collects 30-day morbidity and mortality data from 480 hospitals in the United States.

 

Average patient age was older than 65, body mass index lower than 30 kg/m2 and American Society of Anesthesiologist class three or four.

 

The researchers found:

 

1. Overall incidence of systematic morbidity was 3.2 percent; there were five mortalities. Four of the mortalities occurred in the inpatient cohort and one in the outpatient cohort.

 

2. The independent risk factors for complications in the multivariate analysis were:

 

•    Dialysis
•    Corticosteroid use
•    Recent sepsis
•    120-plus minute operative times

 

3. There were no significant differences in complications between the inpatient and outpatient groups. Outpatient treatment was not a significant risk factor for complications.

 

4. A study published last year in the International Journal of Spine Surgery examined the safety and efficacy of ACDF in the outpatient setting. The researchers found total hospital stay was 4.7 hours on average for single-level procedures, with the maximum stay of 8.2 hours.

 

"There were no major operating complications and neither readmissions nor deaths after discharge," according to the study authors. "There were two transfers from ambulatory surgical centers to inpatient status for observation only."

 

5. Previous studies show the cost of inpatient one- and two-level procedures is $6,739 to $15,000; outpatient ACDF can save between $4,000 and $8,000 on these procedures.
 

An article published in Spine examined the cost of thoracic and lumbar vertebroplasty from 2001 to 2005 among Medicare part B patients. The nationwide inflation-adjusted charges were $76 million for 14,142 cases in 2001 and $152.3 million for 29,090 cases in 2005. Study authors found inpatient cases generated most of the charges, and noted procedures performed in freestanding facilities were "of growing importance."

 

More articles on spine surgery:
The most valuable leader in spine: 5 ways to become a sustainable spine champion
10 observations on deep surgical site infection for growing-rod scoliosis surgery
Good news for spine surgery: 4 surgeons on positive trends

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