Day Case Cervical Spine Surgery: A Retrospective Case Series

Introduction: Aim - evaluate the safety and efficacy of day case cervical spine surgery, specifically Anterior Cervical Discectomy and Fusion (ACDF), in reducing hospital length of stay (LOS) without compromising patient outcomes.

The National Getting It Right First Time initiative promotes day-case posterior lumbar decompression and discectomy, and data from the United States demonstrates the safety of day-case ACDF. There is limited data regarding this practice within the United Kingdom.

Methods: A retrospective review of theatre databases was conducted for all ACDF and cervical disc replacement procedures performed between 2017 and 2022. All cases performed under Consultant Neurosurgeons in JCUH were selected and categorised into two groups,i.e LOS < 24 hours (day-case) and ≥24 hours (inpatient). Electronic patient records were reviewed to collect data on demographics, LOS, readmission and/or re-operation within 30 days, and symptom status at follow-up.

Results: 319 cases were identified - 88% were LOS of ≥24 hours; 12% were LOS < 24 hours.
LOS ≥24 hours group - slight female predominance at a ratio of 1.2:1
LOS < 24 hours group - slight male predominance at a ratio of 1.1:1
No patients in the LOS < 24 hours group had a drain.
In the LOS < 24 hours group, 84.2% had symptom resolution vs 46.6% in the LOS ≥ 24 hours group, with p value of 0.000004 ( < 0.05), suggesting a statistically significant association between LOS and symptom resolution.
LOS ≥24 hours group, 2% were readmitted within 30 days and 1% were reoperated within this time frame; LOS < 24 hours group, 3% were readmitted and no patients were reoperated. Main causes are hematoma, pneumonia & dysphagia.
All day-case surgeries were single-level procedures, with intraoperative x-rays performed to check cage positions.

Conclusion : Day case ACDF are safe and produced outcomes comparable to inpatient cases. Cost-analysis is needed to evaluate the economic benefits of this. Optimal patient selection, use of intraoperative x-rays, and avoidance of drains where safe may facilitate effective day case ACDF surgery.