Best Practices for Outpatient Anterior Cervical Surgery

Anita Mohandas, Chris Summa, W. Bradley Worthington, Jason Lerner, Kevin Foley, Robert J. Bohinski, Gregory B. Lanford, Carol Holden, Richard N.W. Wohns

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Study Design. Delphi Panel expert panel consensus and narrative literature review. Objective. To obtain expert consensus on best practices for patient selection and perioperative decision making for outpatient anterior cervical surgery (anterior cervical disc fusion (ACDF) and cervical total disc replacement (CTDR)). Summary of Background Data. Spine surgery in ambulatory settings is becoming a preferred option for both patients and providers. The transition from traditional inpatient environments has been enabled by innovation in anesthesia protocols and surgical technique, as well as favorable economics. Studies have demonstrated that anterior cervical surgery (ACDF and CTDR) can be performed safely on an outpatient basis. However, practice guidelines and evidence-based protocols to inform best practices for the safe and efficient performance of these procedures in same-day, ambulatory settings are lacking. Methods. A panel of five neurosurgeons, three anesthesiologists, one orthopedic spine surgeon, and a registered nurse was convened to comprise a multidisciplinary expert panel. A three-round modified-Delphi method was used to generate best-practice statements. Predetermined consensus was set at 70% for each best-practice statement. Results. A total of 94 consensus statements were reviewed by the panel. After three rounds of review, there was consensus for 83 best-practice statements, while 11 statements failed to achieve consensus. All statements within several perioperative categories (and subcategories) achieved consensus, including preoperative assessment (n = 8), home-care/follow-up (n = 2), second-stage recovery (n = 18), provider economics (n = 8), patient education (n = 14), discharge criteria (n = 4), and hypothermia prevention (n = 6). Conclusion. This study obtained expert-panel consensus on best practices for patient selection and perioperative decision making for outpatient anterior cervical surgery (ACDF/CTDR). Given a paucity of guidelines and a lack of established care pathways for ACDF/CTDR in same-day, ambulatory settings, results from this study can supplement available evidence in support of local protocol development for providers considering a transition to the outpatient environment.

Original languageEnglish (US)
Pages (from-to)E648-E659
JournalSpine
Volume42
Issue number11
DOIs
StatePublished - Jun 1 2017

Fingerprint

Practice Guidelines
Consensus
Outpatients
Total Disc Replacement
Patient Selection
Decision Making
Spine
Economics
Patient Education
Home Care Services
Hypothermia
Ambulatory Surgical Procedures
Inpatients
Anesthesia
Nurses
Guidelines

All Science Journal Classification (ASJC) codes

  • Orthopedics and Sports Medicine
  • Clinical Neurology

Cite this

Mohandas, A., Summa, C., Worthington, W. B., Lerner, J., Foley, K., Bohinski, R. J., ... Wohns, R. N. W. (2017). Best Practices for Outpatient Anterior Cervical Surgery. Spine, 42(11), E648-E659. https://doi.org/10.1097/BRS.0000000000001925

Best Practices for Outpatient Anterior Cervical Surgery. / Mohandas, Anita; Summa, Chris; Worthington, W. Bradley; Lerner, Jason; Foley, Kevin; Bohinski, Robert J.; Lanford, Gregory B.; Holden, Carol; Wohns, Richard N.W.

In: Spine, Vol. 42, No. 11, 01.06.2017, p. E648-E659.

Research output: Contribution to journalArticle

Mohandas, A, Summa, C, Worthington, WB, Lerner, J, Foley, K, Bohinski, RJ, Lanford, GB, Holden, C & Wohns, RNW 2017, 'Best Practices for Outpatient Anterior Cervical Surgery', Spine, vol. 42, no. 11, pp. E648-E659. https://doi.org/10.1097/BRS.0000000000001925
Mohandas A, Summa C, Worthington WB, Lerner J, Foley K, Bohinski RJ et al. Best Practices for Outpatient Anterior Cervical Surgery. Spine. 2017 Jun 1;42(11):E648-E659. https://doi.org/10.1097/BRS.0000000000001925
Mohandas, Anita ; Summa, Chris ; Worthington, W. Bradley ; Lerner, Jason ; Foley, Kevin ; Bohinski, Robert J. ; Lanford, Gregory B. ; Holden, Carol ; Wohns, Richard N.W. / Best Practices for Outpatient Anterior Cervical Surgery. In: Spine. 2017 ; Vol. 42, No. 11. pp. E648-E659.
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abstract = "Study Design. Delphi Panel expert panel consensus and narrative literature review. Objective. To obtain expert consensus on best practices for patient selection and perioperative decision making for outpatient anterior cervical surgery (anterior cervical disc fusion (ACDF) and cervical total disc replacement (CTDR)). Summary of Background Data. Spine surgery in ambulatory settings is becoming a preferred option for both patients and providers. The transition from traditional inpatient environments has been enabled by innovation in anesthesia protocols and surgical technique, as well as favorable economics. Studies have demonstrated that anterior cervical surgery (ACDF and CTDR) can be performed safely on an outpatient basis. However, practice guidelines and evidence-based protocols to inform best practices for the safe and efficient performance of these procedures in same-day, ambulatory settings are lacking. Methods. A panel of five neurosurgeons, three anesthesiologists, one orthopedic spine surgeon, and a registered nurse was convened to comprise a multidisciplinary expert panel. A three-round modified-Delphi method was used to generate best-practice statements. Predetermined consensus was set at 70{\%} for each best-practice statement. Results. A total of 94 consensus statements were reviewed by the panel. After three rounds of review, there was consensus for 83 best-practice statements, while 11 statements failed to achieve consensus. All statements within several perioperative categories (and subcategories) achieved consensus, including preoperative assessment (n = 8), home-care/follow-up (n = 2), second-stage recovery (n = 18), provider economics (n = 8), patient education (n = 14), discharge criteria (n = 4), and hypothermia prevention (n = 6). Conclusion. This study obtained expert-panel consensus on best practices for patient selection and perioperative decision making for outpatient anterior cervical surgery (ACDF/CTDR). Given a paucity of guidelines and a lack of established care pathways for ACDF/CTDR in same-day, ambulatory settings, results from this study can supplement available evidence in support of local protocol development for providers considering a transition to the outpatient environment.",
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