Our Summary

The study is about a surgical procedure called Anterior Cervical Discectomy and Fusion (ACDF), which is increasingly being performed in outpatient settings (where patients go home the same day of the surgery). However, the safety of doing this procedure as an outpatient isn’t well understood, so the researchers decided to look at what other studies have found. They found 21 relevant articles, but noted that most were retrospective studies (looking back at past data) and there weren’t any high-quality studies.

When comparing the safety of outpatient ACDF with inpatient ACDF (where patients stay in the hospital overnight), they didn’t find any significant difference in terms of complications like stroke, blood clots, difficulty swallowing, or bleeding. However, they did find that patients who had the surgery as an outpatient had lower rates of needing another operation, lower death rates, and shorter hospital stays.

The researchers concluded that outpatient ACDF can be safe for certain patients, but not for everyone, especially older patients or those with other health conditions like obesity. They emphasized the need for doctors to carefully consider each patient’s situation. They also stressed the need for more high-quality studies to confirm these findings.

FAQs

  1. What is Anterior Cervical Discectomy and Fusion (ACDF)?
  2. What did the study find about the safety of outpatient ACDF compared to inpatient ACDF?
  3. Who might not be suitable for outpatient ACDF according to the study?

Doctor’s Tip

A doctor might tell a patient considering a discectomy to carefully consider their individual health situation before opting for outpatient surgery. Older patients or those with other health conditions like obesity may not be good candidates for outpatient discectomy and may benefit from staying in the hospital overnight. It is important to discuss all options and potential risks with your doctor before making a decision.

Suitable For

Patients who are typically recommended for discectomy are those who have not responded to conservative treatments such as physical therapy, medications, and injections for conditions such as herniated discs, spinal stenosis, or degenerative disc disease. Patients who have significant pain, weakness, or numbness in the arms or legs that is not improving with non-surgical treatments may be candidates for discectomy. It is important for patients to be evaluated by a spine specialist to determine if they are appropriate candidates for this surgical procedure.

Timeline

Before a discectomy, a patient may experience symptoms such as pain, numbness, tingling, or weakness in the neck, arms, or hands due to a herniated disc pressing on a nerve in the spine. They may undergo diagnostic tests such as imaging studies and possibly physical therapy or medications to manage their symptoms.

After a discectomy, the patient will undergo the surgical procedure to remove the herniated disc and relieve pressure on the affected nerve. They will typically be monitored in the hospital for a period of time before being discharged. Post-operatively, the patient will undergo physical therapy and rehabilitation to regain strength and mobility in the affected area. They may also need to follow specific instructions for wound care, pain management, and activity restrictions.

Overall, the goal of a discectomy is to alleviate symptoms and improve the patient’s quality of life by addressing the underlying cause of their spinal condition. With proper care and follow-up, most patients can expect to see improvements in their symptoms and function after undergoing a discectomy.

What to Ask Your Doctor

  1. Is outpatient ACDF a suitable option for me, or are there specific criteria that need to be met for it to be safe?

  2. What are the potential risks and complications associated with outpatient ACDF compared to inpatient ACDF?

  3. How will my recovery and post-operative care differ if I have the surgery as an outpatient versus staying in the hospital overnight?

  4. What are the specific factors that make outpatient ACDF a safer option for certain patients, and do I meet those criteria?

  5. Are there any long-term implications or differences in outcomes between outpatient and inpatient ACDF that I should be aware of?

  6. What is the success rate of outpatient ACDF compared to inpatient ACDF in terms of relieving symptoms and improving function?

  7. How will pain management be handled after the surgery if I go home the same day?

  8. What follow-up appointments or care will be necessary if I have the surgery as an outpatient?

  9. Are there any specific precautions or guidelines I need to follow after outpatient ACDF to ensure a successful recovery?

  10. Do you recommend outpatient ACDF for me, and if so, why do you believe it is a safe and appropriate option in my case?

Reference

Authors: Yerneni K, Burke JF, Chunduru P, Molinaro AM, Riew KD, Traynelis VC, Tan LA. Journal: Neurosurgery. 2020 Jan 1;86(1):30-45. doi: 10.1093/neuros/nyy636. PMID: 30690479