Comparative Analysis of Surgical Outcomes in Outpatient vs. Inpatient Laminoplasty for Cervical Spondylosis: A Non-inferiority Study

Introduction: With a recent shift towards outpatient spinal procedures, largely driven by evidence of reduced hospital-related risks and improved value-based care, this study evaluates the non-inferiority of surgical outcomes between outpatient and inpatient laminoplasty for cervical spondylosis.

Methods: The American College of Surgeons National Surgical Quality Improvement Program database was analyzed to identify patients who underwent cervical laminoplasty for spinal spondylosis. To enhance comparability between the two groups, patients with hospital stays exceeding 48 hours or those who underwent additional spinal procedures during the same admission were excluded. Key outcomes included rates of postoperative complications, readmissions, and reoperations within 30 days post-surgery. Non-inferiority of outpatient versus inpatient surgery was established with a risk difference threshold of < 10.0% at a one-sided 97.5% confidence interval.

Results: The study included 808 cervical laminoplasty cases, with 107 and 701 patients in the outpatient and inpatient groups, respectively. Baseline characteristics were comparable between groups, except for age (58.3 ± 10.6 vs. 61.4 ± 11.5 years, p=0.01). The outpatient and inpatient groups experienced postoperative complication rates of 2.8% and 3.4%, respectively, and both had a 30-day readmission rate of 3.7%. Reoperation rates within 30 days were 2.8% for the outpatient group and 1.4% for the inpatient group. Outpatient surgery met the non-inferiority criteria for postoperative complications, readmissions, and reoperations, with a risk difference of 10%.

Conclusion : Outpatient cervical laminoplasty showed similar early postoperative outcomes to inpatient surgery, confirming non-inferiority in surgical outcomes between outpatient and inpatient cervical laminoplasty.