Outpatient Anterior Cervical Discectomy and Fusion

Outpatient Anterior Cervical Discectomy and Fusion

Outpatient Anterior Cervical Discectomy and Fusion

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In times past,  people were admitted to the hospital for the simplest of surgical procedures.  In the 1970’s,  a two week admission to the hospital for a simple carpal tunnel surgery was routine.  People would be admitted  a day or two before surgery to get testing.  Surgery was then performed.  Then,  the patient was discharged when the wound was almost healed.  Fast forward to today,  the patient arrives at the surgery center,  90 minutes before the operation.  the carpal tunnel operation is performed with a form of local anesthesia, with mild sedation.  The patient is discharged from the surgery center within two hours of the operation.  Imaging the cost differences,  the convenience factors,  and the worker productivity issues.

Spine surgery is also becoming more and more of an outpatient surgical procedure.  While simple back discectomy routinely go home on the day of the operation,  there has still been some hesitancy about doing Anterior Cervical Discectomy and Fusion surgery on an outpatient basis.

I will confess that two years ago,  I still admitted patients to the hospital,  and closely monitored them  before discharging the patients the next day.  The concern was about potential breathing problems after the surgery.  There is reports that a small percentage of patients who have this surgery may develop some difficulty breathing.   Usually it is secondary to development of a blood clot,  or hematoma.  The other factor is patients with prior respiratory problems.  Other studies indicate it may also be related to the length of time for the surgery as well as the number of levels being fused.

For the past two years,  I have discharged most of my Anterior Cervical  Discectomy and Fusion patients on the Day of surgery  with much greater patient satisfaction,  and reduced costs.

A recent study by McGirt et al demonstated the efficacy of one and two level Anterior Cervical Discectomy and Fusion Surgery performed on an outpatient basis.  There were no additional complications,  and the cost savings average $7k.

In my practice,  I now assume healthy patients,  without prior breathing difficulties,  and no history of developing hematoma blood clots are scheduled to leave the surgery facility that day.  For others with risk factors,  I will continue to admit overnight.  In my opinion,  this is the right balance between sending everyone home as an outpatient,  versus keeping everyone admitted overnight in the hospital.   I find most patients would rather sleep in their own bed,  and eat their own food.   Only those who have potential risks such as more than two level surgery,  prior neck surgery,  asthma,  use of blood thinners,  or poor medical conditions need to stay as an inpatient.

 

Citations

  • McGirt MJ, Godil SS, Asher AL, Parker SL, Devin CJ. Quality analysis of anterior cervical discectomy and fusion in the outpatient versus inpatient setting: analysis of 7288 patients from the NSQIP database. Neurosurg Focus. 2015 Dec;39(6):E9. PubMed PMID: 26621423

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Author and Contributor to www.Spine-Health.com – July, 2015

www.Spine-Health.com/author/john-h-shim-md-facs

Chief of Surgery, Mease Countryside and Mease Dunedin Hospitals, Safety Harbor and Dunedin, Florida. 2014-2016.

Orthopaedic Section Chief Mease Countryside Hospital; Safety Harbor, Florida Mease Dunedin Hospital; Dunedin, Florida.2008-2013

Board Member Morton Plant Mease Research Council

Co-Director of Mease Neuro-Ortho Spine Center Mease Dunedin Hospital; Dunedin, Florida.

One of “6 Spine Physicians Ranked #1 on Google” – December 2016

Top Ten Most Liked Spine Surgeons on the Internet – July 2016

2016 Spine Surgeons to Know list – January 2016

2014 Spine Specialists to know list – September 2014

One of Ten Leaders of Certified Spine Programs – December 2011

 

The Best Orthopedics in Tampa

The information provided on this website does not provide or should be considered medical advice. It is not a substitute for diagnosis or treatment of any condition. The information provided is for informational purposes only. You should not rely solely on the information provided on this website in making a decision to pursue a specific treatment or advice. You should consult directly with a professional healthcare provider.

As a condition of using the information on this website, ShimSpine and its physicians are not responsible for any advice, diagnosis, treatment or outcome you may obtain.

ShimSpine.com is completely self-funded. No outside funds are accepted or used. This website does not utilize paid advertising as a source of revenue.
Outpatient Spine Surgery Considerations. www.Spine-Health.com. January 2016.

What is Spinal Stenosis? www.Spine-Health.com. October 2015.

Surgeon insights on the Changing Landscape of Orthopedic Care. OrthopedicToday. June 2014

Chapter 33: Interspinous Spacers. Shim JH, Mazza JS, Kim DH Published in Minimally Invasive Percutaneous Spinal Techniques. Elsevier Health Sciences, Philadelphia, Pennsylvania. (Published 2011)

Chapter 35: Minimally Invasive Percutaneous Lumbar Fusion Technique.Shim JH, Mazza JS, Kim DH Published in Minimally Invasive Percutaneous Spinal Techniques. Elsevier Health Sciences, Philadelphia, Pennsylvania. (Published 2011)

March 2010 Minimally Invasive Transforaminal Lumbar Interbody Fusion American Academy of Orthopaedic Surgeons Annual Meeting New Orleans, Louisiana February 2010

February 2010 A Review of Dynamic Stabilization in the Lumbar Spine Selby Spine Symposium; Park City, Utah

November 2009 Lumbar Spinal Stenosis Community Based Lecture; Tampa, Florida

September 2009 Instructor/Proctor Minimally Invasive Lumbar Cadaver Lab; Tampa, Florida

February 2009 New Spinal Technology: Cervical Disc Replacement and Interspinous Spacers. Selby Spine Symposium; Park City, Utah

February 2008 The Degenerative Spine: The Role of Dynamic Lumbar Stablization and Interspinous Spacers Selby Spine Symposium; Park City, Utah

October 2008 Emerging Technology and Techniques in Spinal Surgery Orthopaedics in the 21st Century Symposium; Morton Plant Mease Healthcare; Largo, Florida

September 2007 Emerging Technology in Spinal Surgery Orthopaedics in the 21st Century Symposium; Morton Plant Mease Healthcare; Largo, Florida

October 2006 Emerging Technology and Techniques in Spinal Surgery Orthopaedics in the 21st Century Symposium; Morton Plant Mease Healthcare; Largo, Florida

May 2005 The Role of Kyphoplasty in the Treatment of Vertebral Compression Fractures Mease Neurosciences Symposium; Clearwater, Florida
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