Safety of Anterior Cervical Discectomy and Fusion Performed as Outpatient Surgery

STUDY DESIGN: Retrospective review of a prospectively collected database. OBJECTIVE: To determine the complications and safety of anterior cervical discectomy and fusion performed on an outpatient basis. SUMMARY OF BACKGROUND DATA: Anterior cervical discectomy and fusion performed as outpatient surgery is an appealing alternative and has many potential benefits. The safety of this practice, however, has not been thoroughly investigated. This study aims to examine the frequency of acute complications and rates of unplanned admissions for anterior cervical discectomy and fusions scheduled as outpatient procedures. METHODS: Data were collected prospectively on 645 consecutive patients undergoing anterior discectomy and fusion by a single surgeon for either stenosis or herniated nucleus pulposus involving 1 level. These data were then retrospectively reviewed for acute complications occurring within 48 hours of surgery. A subset consisting of the last 392 patients were further reviewed to better characterize this population. Complications after surgery as well as procedures requiring postoperative admission for any reason were detailed. RESULTS: Two of 645 (0.3%) patients developed acute complications, both of which were epidural hematomas. Both occurred within the protocol's mandatory 4 hours postoperative observation time. Both resolved without permanent neurologic deficit. There were no retropharyngeal hematomas and no deaths. Six percent of patients required an unplanned admission. More than 80% of unplanned admissions were secondary to either pain or nausea. CONCLUSIONS: One-level anterior cervical discectomy and fusion can be safely performed in an outpatient setting with a 4-hour observation period. There is a low rate (6%) of unplanned admission to the hospital. The number of unplanned admissions can be decreased by more than one-third if autogenous iliac crest bone graft is not harvested. The use of postoperative drains for 1-level anterior discectomy and fusion is called into question.