Perioperative complications of inpatient and outpatient single-level posterior cervical foraminotomy: a comparative retrospective study |
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| Affiliation: | 1. Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA;2. Department of Orthopaedic Surgery, Faculty of Medicine, Menoufia University, Shibin El Kom, Egypt;1. Department of Orthopedic Surgery, Warren Alpert Medical School of Brown University, 2 Dudley St, Providence, RI, 02905, USA;2. Warren Alpert Medical School of Brown University, 2 Dudley St, Providence, RI, 02905, USA;1. Department of Orthopaedic Surgery, Brigham and Women''s Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115, USA;2. New York Spine Institute, New York University Langone Medical Center, 761 Merrick Ave, Westbury, NY 11590, USA;3. Department of Neurosurgery, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02214, USA;4. Department of Orthopaedic Surgery, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02214, USA;1. Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, New York, NY, USA;2. Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA;3. Department of Neurosurgery, University of Virginia Medical Center, Charlottesville, VA, USA;4. Department of Orthopaedic Surgery, Warren Alpert School of Medicine, Brown University, Providence, RI, USA;5. Department of Orthopedic Surgery, Rocky Mountain Scoliosis and Spine Center, Denver, Colorado, USA;6. Deparment of Orthopedic Surgery, Hospital for Special Surgery, New York, NY, USA;7. Department of Neurosurgery, University of South Florida, Tampa, FL, USA;8. Division of Orthopaedic Surgery, Scripps Clinic, La Jolla, CA, USA;9. Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA;10. Department of Orthopaedic Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA;11. Department of Orthopaedic Surgery, Swedish Neuroscience Institute, Seattle, WA, USA;12. Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA;13. Rocky Mountain Scoliosis and Spine, Denver, CO, USA;1. Department of Neurosurgery, Haaglanden MC & Leiden University MC, Leiden, the Netherlands;2. Department of Neurosurgery, Erasmus MC, University Medical Centre, Rotterdam, the Netherlands;1. Department of Orthopedic Surgery, University of Michigan, Ann Arbor, MI, USA;2. Henry Ford Health System, Detroit, MI, USA;3. Department of Neurosurgery, University of Michigan, Ann Arbor, MI, USA;4. Beaumont Health System, Royal Oak, MI, USA;1. Department of Orthopedic Surgery, Spine Lab, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People''s Republic of China;2. Department of Physical Therapy, Faculty of Health Sciences, University of Western Ontario, London, Ontario, Canada |
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| Abstract: | BACKGROUND CONTEXTPosterior cervical foraminotomy (PCF) is a relatively safe procedure for the treatment of cervical radiculopathy. Though most often performed as an inpatient procedure, there is an increasing number of patients treated in an outpatient setting.PURPOSEThis study aimed to compare the perioperative complication rates associated with inpatient and outpatient single-level PCF.STUDY DESIGN/SETTINGRetrospective database study.PATIENT SAMPLEPatients with cervical radiculopathy who underwent inpatient or outpatient single-level PCF between 2007 to the first quarter of 2016.OUTCOME MEASURESCharlson Comorbidity Index (CCI) was used as a broad measure of comorbidity. Surgical complications included cervical nerve root injury, dural tear, wound complications, infection, dysphagia, cervicalgia, and revision surgery. Medical complications included pulmonary embolism and lower limb deep vein thrombosis, acute myocardial infarction, acute respiratory failure, pneumonia, sepsis, and urinary complications.METHODSThis study was a retrospective review of patients who received single-level PCF from 2007 to the first quarter of 2016 as either outpatients or inpatients using the Humana subset of the PearlDiver Patient Record Database. The incidence of perioperative medical and surgical complications was queried using relevant International Classification of Diseases (ICD-9-CM and ICD-10-CM) and Current Procedural Terminology codes. Multivariate logistic regression analysis, adjusted for age, gender, and CCI, was performed to calculate odds ratios (ORs) of complications among inpatients relative to outpatients treated with PCF. Propensity score matching was done, and comparisons were made for postoperative complications.RESULTSThroughout the time period, 1,469 and 1,192 patients received inpatient and outpatient single-level PCF, respectively. The mean CCIs±standard deviation of inpatient and outpatient groups undergoing PCF were 2.83±3.11 and 1.46±2.21, respectively (p<.001). After propensity score matching, patients who received PCF in an inpatient setting showed significantly higher rates of wound complications (OR=1.53, 95% confidence interval [CI]=1.04–2.23; p=.029), infection (OR=1.91, CI=1.15–3.15; p=.012), acute respiratory failure (OR=2.50, CI=1.23–5.08; p=.011), and urinary tract infections and incontinence (OR=2.11, CI=1.32–3.38; p=.002).CONCLUSIONSOutpatient single-level PCF was associated with a lower rate of perioperative medical and surgical complications. The PCF in the outpatient setting can potentially be a safe procedure for the treatment of cervical radiculopathy with appropriate patient selection. |
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