Please use this identifier to cite or link to this item: http://hdl.handle.net/1946/18166
Introduction: Anterior cervical interbody fusion (ACIF) is an established procedure for cervical radiculopathy that has not answered conservative treatments. Since December 2012, the neurosurgical department at the Aarhus University Hospital has been performing this procedure in an outpatient setting for selected patients. The main concern with the outpatient setting is the risk of retropharyngeal hematoma. The aim of this study is to evaluate the ACIF procedure in this novelty setup and compare to international literature.
Methods and materials: All patients from December 2012 to December 2013 were included. They had a structured telephone nurse-lead interview one week and eight weeks post-surgery. Patient files were reviewed for baseline and pre-surgical data and post-surgery complications. Statistical calculations were done in STATA. McNemar’s test with hypothesis of no difference was applied.
Results: 55 consecutive patients were included. There was a significant reduction in upper extremity pain at one week and eight weeks, risk ratio (RR) = 0.48 [95% CI=0.34-0.66], p<0.01 and RR=0.46 [0.31-0.67], p<0.01, respectively. There was also significant reduction in neck pain at eight weeks (RR=0.70 [0.53-0.91], p=0.01). Incidence of upper extremity paresthesia (RR=0.74 [0.40-1.13], p=0.24) and motor weakness (RR=0.8 [0.54-1.18], p=0.45) had a tendency to improve at eight weeks, although it was not statistically significant. Complications occurred in three patients (5%): One root lesion and two cases of hemorrhage (one with 1000 mL bleeding with the patient re-admitted within a month; one with 400 mL bleeding in which the decompression could not be finished and the patient was moved to a regular ward). Six other events occurred (11%): two large hemorrhages (350 mL and 250 mL, respectively); two cases of hoarseness requiring medical intervention; two patients with adjacent disc disease requiring new ACIF surgery within 8 months of the original surgery.
Discussion: The follow-up frequency is lower than expected and may call on re-evaluation of the follow-up method used. The number of total events seems higher than expected, further analyzes are needed to outline causes. A more rigorous and constant follow-up is recommended to insure patient safety.
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