To print: Select File and then Print from your browser's menu --------------------------------------------------------------------------------------- Title: NASS: Cervical-Spine Surgery in an Ambulatory Surgery Center Is Safe URL: http://www.pslgroup.com/dg/23E07E.htm Doctor's Guide November 7, 2003
By Maury M. Breecher, PhD, MPH SAN DIEGO, CA -- November 7, 2003 -- Anterior cervical-spine surgery, including complex multi-level cases, pseudoarthrosis repair and corpectomy, can be safely performed in an ambulatory-surgery setting with the appropriate safeguards, according to a study presented here October 23rd at the 18th Annual Meeting of the North American Spine Society Advances in surgical technique in anesthesia combined with a more cost-conscious health-care environment have led to a trend towards performing more surgical procedures in an outpatient setting. The safety and efficacy of outpatient surgical microdiscectomy and fusion limited to level 1 and 2 procedures has previously been reported.1 Similarly, good results have been reported in outpatient cervical posterior laminoforaminotomy and outpatient lumbar microdiscectomy,2 said lead author Kamshad Raiszadeh, MD, La Jolla Spine Institute, California, United States. The study was an analysis of 92 patients undergoing 102 anterior cervical-spinal procedures at the Orthopedic Surgery Center at La Jolla and the Coast Surgical Center who had received treatments from January 2001 and January 2003. Surgical procedures included 1, 2 and 3 anterior cervical discectomy and fusion (ADCF), anterior pseudoarthrosis repair and anterior corpectomy and implant removal cases. The 102 cases were reviewed by seven surgeons, four orthopaedic spinal surgeons and three neurosurgeons. Ninety-seven patients underwent anterior cervical plating with fusion. Eighty cases (78%) were primary, and 22 cases (22%) were revision cases. The primary cases included 32 level-1ACDF cases, 42 level-2 ACDF, 3 level-3 ACDF, and 3 level-2 corpectomies. The revision cases included 6 level-1 pseudoarthrosis repairs, 5 level-2 pseudoarthrosis repairs, 4 level-1 pseudoarthrosis repairs with level-2 ACDF, 2 level-2 pseudoarthrosis repairs with level-2 ACDF, and 5 implant removals. The most cephalad level fused was C2, and the most caudal level fused was C7. Thirteen patients (13%) underwent iliac-crest autograft harvesting. The average age of the 54 females and 48 males at time of surgery was 46.6 years. Eighteen patients had co-morbidities, including hypertension, asthma and diabetes; 31 patients were smokers. Patients were monitored postoperatively in the post-anesthesia care unit with a 2:1 patient-to-nurse ratio with oversight observation capability for a 23-hour period under the care of an in-house anesthesiologist. In accordance with the centre's protocol, all patients were required to ingest oral liquids, void spontaneously, ambulate without resistance, and have a responsible adult available to transport the patient home prior to discharge. All patients were discharged to go home within 23 hours after surgery. All were contacted the day after their surgery, and none reported complications. Sixty-four patients (62%) were available for a follow-up interview. The average length of follow-up was 18.1 months. Patient satisfaction was high, with 92% reporting a good or excellent surgery experience, the authors reported. Ninety-one percent of the patients said they would do surgery in a surgery center if they needed to. "Ambulatory anterior cervical surgery is safe, and can include revision anterior cervical surgery, corpectomy, pseudoarthrosis repair and multilevel procedures from C2 to C7 with or without use of autograph," concluded the authors. REFERENCES 1. Silvers H.R., Lewis, P. J., et al. (1996). "Day surgery for cervical microdiscectomy: is it safe and effective?" J Spinal Disord 9 (4) (unknown page) 2. Tomaras, C R. Blacklock, J.B., et al. (1997) "Outpatient Surgical Cervical Radiculopathy." JNeurosurg 87(1): 41-3. [Study Title: Cervical Spine Surgery in an Ambulatory Surgery Center. Abstract 8] --------------------------------------------------------------------------------------------- Copyright © 1999 P\S\L Consulting Group Inc. All rights reserved. Republication or redistribution of P\S\L content is expressly prohibited without the prior written consent of P\S\L. P\S\L shall not be liable for any errors, omissions or delays in this content or any other content on its sites, newsletters or other publications, nor for any decisions or actions taken in reliance on such content. --------------------------------------------------------------------------------------------- This news story was printed from *Doctor's Guide to the Internet* located at http://www.docguide.com --------------------------------------------------------------------------------------- Return to News Story Page This site is maintained by webmaster@pslgroup.com Please contact us with any comments, problems or bugs. All contents Copyright (c) 1998 P\S\L Consulting Group Inc. All rights reserved.