No Significant Differences in Postoperative Complications Between Outpatient and Inpatient Single-Level or Multiple-Level Cervical Disc Replacement for Cervical Radiculopathy

STUDY DESIGN: Retrospective Cohort Analysis. OBJECTIVE: To investigate the safety profile of outpatient versus inpatient single-level and multiple-level CDR by analyzing 1-year and 2-year surgical outcomes and 90-day medical complications using a large patient database. SUMMARY OF BACKGROUND DATA: Cervical disc replacement (CDR) is becoming a more desirable option for patients undergoing cervical spine procedures. Unlike anterior cervical discectomy and fusion (ACDF), CDR is motion-preserving and has been shown to reduce rates of adjacent segment disease. Current literature investigating outpatient versus inpatient CDR has shown a similar safety profile among the two cohorts. However, most of these studies have relatively small sample sizes with short-term follow-up. METHODS: A retrospective cohort study was done using the PearlDiver patient database between 2010 and 2019. Patients who underwent single-level and multiple-level CDR with a follow-up of at least 2 years were identified. Patients within each procedure cohort were subdivided into an outpatient and an inpatient group. Univariate and multivariable analyses were performed. RESULTS: In total, 2294 patients underwent single-level CDR of which 506 patients underwent outpatient CDR and 1788 underwent inpatient CDR. In total, 236 patients underwent multiple-level CDR of which 49 patients underwent outpatient CDR and 187 underwent inpatient CDR. In the single-level CDR cohort, patients undergoing outpatient CDR were found to have lesser odds of a decompressive laminectomy at 1-year following the initial procedure (OR: 0.471; CI: 0.205 to 0.945; P=0.05). No significant differences in 1-year and 2-year surgical complications, or 90-day postoperative complications, were found on multivariate analysis of outpatient versus inpatient multiple-level CDR. CONCLUSIONS: Our study found that performing single-level and multiple-level CDR on an outpatient basis has a similar safety profile to patients who underwent these procedures in an inpatient setting. LEVEL OF EVIDENCE: III