Can Anterior Discectomy and Fusion (ACDF) Surgery be Safely Performed in an Outpatient Setting? A Systematic Review on the Post-operative Complication and Readmission Rates

Author(s): Salman Ghani, BEng, MSc, MBBS, Ahmed Ali Kayyale, MBBS

Background:

Anterior Cervical Discectomy and Fusion (ACDF) is a common surgical procedure used to treat cervical spine disorders. The safety and efficacy of outpatient versus inpatient ACDF settings have been debated, with varying findings reported in the literature. This study aims to evaluate and compare post-operative complication reporting frequency, numerical rate and readmission rates and readmission rates between outpatient and inpatient ACDF surgeries.

Methods:

A systematic review was performed between 1996 and 2024 using PubMed, Medline and Embase. Thirty one studies were included, 22 compared inpatient and outpatient settings directly and nine that focused solely on outpatient settings. Data were analysed on the overall rates of major and minor post-operative complications, frequency of specific complications, and readmission rates. Statistical significance was assessed using p-value of <0.05.

Results:

Results showed that inpatient ACDF surgeries had a higher interquartile range of overall complication rates compared to outpatient surgeries. Specifically, inpatients reported complication rates ranging from 0% to 31.36%, while outpatients ranged from 0.001% to 34.59%. Sixteen out of twenty two studies demonstrated higher complication rates for inpatients, with statistically significant differences observed in mortality, haematoma, dysphagia, respiratory and dural complications. Conversely, dysphagia was reported at higher rates in outpatients in one statistically significant study. Readmission rates were also higher for inpatients, ranging from 0% to 44.2%, compared to 0% to 24.69% for outpatients. The findings suggest that outpatient ACDF surgeries are associated with lower overall complication rates and readmission rates compared to inpatient procedures. The variability in complication rates and readmission may be influenced by differences in patient selection, procedural complexity, and post-operative monitoring.

Conclusion:

Outpatient ACDF surgery appears to be as safe and effective as inpatient surgery, with advantages including lower readmission rates and fewer major complications. Despite some discrepancies, particularly concerning dysphagia, the overall evidence supports the efficacy of outpatient ACDF. Further research with standardised definitions and methodologies is needed to confirm these findings and better understand the implications for clinical practice.