Early Discharge for Anterior Cervical Fusion Surgery: Prediction of Readmission and Special Considerations for Older Adults

• Main Authors: Yu-Chun Chen, Jau-Ching Wu, Hsuan-Kan Chang, Wen-Cheng Huang
• Format: Article
• Language: English
• Published: MDPI AG 2019-02-01
• Series: International Journal of Environmental Research and Public Health
• Subjects: anterior cervical discectomy and fusion (ACDF); early discharge (ED); incidence rates; readmission; reoperation
• Online Access: https://www.mdpi.com/1660-4601/16/4/641

Anterior cervical discectomy and fusion (ACDF) is the standard surgical management for disc herniation and spondylosis worldwide and reportedly performed with short hospitalization and early discharge (ED). However, it is unknown if ED improves the outcomes of ACDF including among older adults. This cohort study included patients who underwent ACDF surgery in Taiwan over two years analyzed in two groups: the ED group (discharged within 48 hours), and the comparison group (hospitalized for more than 48 h). Both groups were followed-up for at least 180 days. Pre- and post-operative comorbidities, re-admissions and re-operations were analyzed using a multivariate cox-regression model, with bootstrapping, and Kaplan&#8315;Meier analysis. Among 5565 ACDF patients, the ED group (<i>n</i> = 405) had a higher chance (crude and adjusted hazard ratio = 2.33 and 2.39, both <i>p </i>&lt; 0.001) of re-admission than the comparison group (<i>n</i> = 5160). The ED group had an insignificant trend toward more re-admissions for spinal problems and re-operations within 180 days. In the ED group, older age (&#8805;60) and hypertension were predictive of re-admission. For ACDF surgery, the ED group had higher rates of re-admission within 180 days of post-op, suggesting that the current approach to ED requires modification or more cautious selection criteria be adopted, particularly for older adults.