1453. 3- and 4-Level ACDF in Elderly Patients: Outpatient Versus Inpatient Peri-Operative Complications and 30-Day Readmissions

Authors: Owoicho Adogwa, MD, MPH; Syed Khalid, MD; Victoria Vuong; Daniel Lilly, BA; Mark Davison, BS; Shyam Desai, BA; Jessica Moreno; Joseph Cheng; Carlos Bagley (St Louis, MO)


Same day 1- and 2-level ACDF procedures have been shown to be safe and equally effective when compared to traditional inpatient procedures. Whether multilevel (> 2 level) ACDFs can safely be performed in elderly patients (>65 years old) in an outpatient remains unknown. The aim of the current study is to compare the post-operative complications profile and 30-day hospital readmission rates in Medicare patients undergoing both inpatient versus outpatient >2 level Anterior Cervical Discectomy and Fusion (ACDF) procedures.


Our population included a total of 9,725 elderly patients(>65 years old) that underwent 3 or more levels ACDF procedure.  9,230 patients underwent an inpatient ACDF, and 495 patients underwent an outpatient ACDF. Patient age, gender, comorbidities, postoperative complications, readmission rates and overall financial cost were compared between both cohorts.


Although patients managed as either inpatients or outpatients did not significantly differ in their baseline comorbidities, patients with Diabetes Mellitus Types I & II and BMI ≥ 30 Kg/m2 were more likely to be managed as inpatients (p= <0.001). The inpatient cohort had a higher incidence of postoperative complications (UTI, DVT, and MI), as well as higher all cause 30-day hospital readmission rates (p= <0.001). Of the outpatients readmitted, a history of anemia (p=<0.0001), Diabetes Mellitus Type I & II ( p= <0.0001), smoking (p= <0.0001), and obesity (p= <0.0001) were found to be associated with higher all cause 30-day hospital readmission rates.


This study suggests that multi-level ACDF procedures may be safely performed in as an outpatient in carefully selected geriatric patients.