Safety profile of multilevel outpatient cervical disc arthroplasty

Background: Efforts are underway to shift an increasing number of procedures to outpatient procedures. The literature has demonstrated high rates of safety, cost savings and patient satisfaction for various spine procedures performed in the outpatient setting. Cervical Disc Arthroplasty (CDA) has become an acceptable surgical treatment option for cervical myelopathy and or radiculopathy. While this procedure has been shown to be safe when performed in an inpatient setting, the safety of performing multilevel CDA in the outpatient setting requires careful assessment. Methods and Results: We searched the Pubmed database using following search keywords: “cervical disc replacement,” “cervical disc arthroplasty,” “multilevel,” “outpatient,” “ambulatory.” Four retrospective cohort studies and one meta-analysis were identified and relevant to the topic. The literature was critically evaluated. Conclusion: Multilevel CDA can be safely performed in the outpatient setting, with lower complication rates, shorter operating times, and similar readmission and reoperation rates compared with inpatient CDA. When choosing to perform this procedure in the ambulatory setting each surgeon should consider their own skill set and familiarity with CDA. While no evidence-based guidelines exist regarding which patients are optimal candidates to perform this procedure on in the outpatient setting, careful patient selection is important. Further prospective randomized studies with larger sample sizes are needed to generate evidence-based protocols for patient selection in order to optimize outcomes and the safety of performing multilevel cervical disc arthroplasty in the outpatient setting.