Spine: The Safety of Single and Multi-level Cervical Total Disc Replacement in Ambulatory Surgery Centers

Study design: Retrospective cohort OBJECTIVE.: Evaluate the safety profile of single and multilevel cervical artificial disc replacement (ADR) performed in an outpatient setting. Summary of background data: As healthcare costs rise, attempts are made to perform an increasing proportion of spine surgery in ambulatory surgery centers (ASCs). ASCs are more efficient, economically and functionally. Few studies have published on the safety profile of multi-level cervical ADR. Methods: We have performed an analysis of all consecutive cervical ADR surgeries that we performed in an ASC over a 9-month period, including multi-level and revision surgery. The pre-, intra- and post-op data recorded included age, gender, BMI, tobacco use and the presence of diabetes; level and procedure, OR time, EBL, complications; discharge site, occurrence of re-operation, hospital admission or any medical complication or infection over a 90-day period. Results: 147 patients underwent 231 treated levels: 71 single-level, 76 multi-level: 69 two-level, 6 three-level, 1 four-level. Average age was 50 +/-10 years; 71 female, 76 males. None of the patients were insulin-dependent diabetics, 4 were current smokers, 16 were former smokers. Average BMI was 26.8 +/-4.6 (range 18-40). Average total anesthesia time was 88 minutes (range 39-168 minutes). Average EBL was 15 ml (range 5-100 ml). 90.3% of patients were discharged directly home, 9.7% to an after-care facility. In the 90-day post-op period there were zero deaths, two hospital admissions (1.4%) – one for medical complication (0.7%) and one for a surgical site infection (0.7%). Conclusion: In this consecutive case series we performed 231 ADRs in 147 patients in the outpatient setting, including multi-level and revision procedures, with 2 minor post-operative complications resulting in hospital unplanned admissions within 90 days. We believe these procedures are safe to perform in an ASC. An efficient surgical team and careful patient selection criteria are critical in making this possible. Level of evidence: 3.