• Ryan Khanna, Robert B Kim, Sandi K Lam, George R Cybulski, Zachary A Smith, and Nader S Dahdaleh.
• Department of Neurosurgery, Northwestern University Feinberg School of Medicine, Chicago, IL.
• Clin Spine Surg. 2018 Feb 1; 31 (1): 43-47.

Study DesignMulticenter propensity score-adjusted retrospective cohort study.ObjectiveTo determine baseline 30-day complication rates for anterior cervical discectomy and fusion (ACDF) and compare clinical complications for patients undergoing single-level ACDFs between inpatient and outpatient settings.Summary Of Background DataACDF remains the most common procedure in the treatment of a variety of cervical disc pathologies, making it a focus of quality improvement initiatives. Outpatient single-level ACDFs are becoming more common and offer advantages including reducing nosocomial infections and costs, as well as improved patient satisfaction.Materials And MethodsThe 2011-2013 NSQIP datasets were queried to identify all patients who underwent single-level ACDF procedures using current procedural terminology codes. Outpatient and inpatient cohorts were matched 1:1 using propensity score analysis to assess short-term outcomes. The outcomes assessed included 30-day medical and surgical complications, reoperation, readmission, and mortality.ResultsIn total, 6940 patients underwent a single-level ACDF with an overall complication rate of 4.2%. A total of 5162 patients (74.4%) had an inpatient hospital stay after surgery, whereas 1778 patients (25.6%) had outpatient surgery. After matching based on preoperative and operative characteristics to account for potential confounders, the overall complication rate was higher in the inpatient arm compared with the outpatient arm (2.5% vs. 1.2%; P=0.003). The 30-day readmission rate was also higher but not significant in the inpatient group than the outpatient group (2.2% vs. 1.8%; P=0.355). Mortality was the same with 0.1% in both groups (P=0.564).ConclusionsPatients undergoing outpatient single-level ACDF had a lower 30-day complication rates than those undergoing it in the inpatient setting. Outpatient surgery for single-level ACDF is safe and a favorable option for suitable patients.Level Of EvidenceLevel 3.

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