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Conference Proceeding

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Abstract Book 51st Annual Meeting Cervical Spine Research Society


Introduction: For patients presenting with cervical radiculopathy or cervical myelopathy, surgical treatment is typically pursued after discussion in the outpatient setting. Yet, there exists a group of patients presenting to the acute care setting with intractable pain or progressive neurologic deficits who are indicated for operative treatment outside of outpatient evaluation. Given the differences in initial management and pre-operative optimization, it is unclear if surgical and post-operative outcomes differ between these populations. Materials and Methods: This was a retrospective cohort study from an academic medical center. Surgical case logs from the institution’s electronic medical record were used to identify patients who underwent anterior cervical discectomy and fusion (ACDF) with 4 fellowship trained orthopaedic spine surgeons from 1/1/2017 to 12/30/2021. Analysis was grouped by admission status to the hospital; those presenting for scheduled outpatient surgery (“Outpatient” group) versus those who underwent surgery after presentation to the emergency department due to acute symptoms (“ED” group). The medical record was reviewed for patient demographic information, subsequent returns to the ED without readmission, post-procedure length of stay (LOS), readmissions, and reoperations. Follow-up for late revision extended through 12/30/2022. Statistical comparisons were performed with Chi-squared and Student’s t-tests. Results: A total of 755 patients were identified for both indications (443 with radiculopathy and 312 with myelopathy); 671 patients (88.9 %) presented for scheduled outpatient surgery and 84 (11.1 %) presented through the ED. Outcomes were dichotomized by presenting complaints (Table 1). Post-operative length of stay (LOS) was shorter for those presenting with radiculopathy versus myelopathy in both the outpatient and EC groups. For those presenting with cervical myelopathy, a significantly higher rate of 90-day re-admissions was observed in patients in the ED group (29.9 % vs 5.9 %; p <.001). Additionally, those indicated for surgery for radiculopathy after presentation to the ED demonstrated a higher rate of return to the ED within 90 days post-operatively (17.9% vs 5.0 %; p = .004). Conclusion: For patients indicated for ACDF after presenting to the acute care setting with cervical radiculopathy, there were relatively higher rates of return to the ED compared to those undergoing planned elective surgery. In this group, post-operative counseling should be focused on identifying issues appropriate for outpatient follow-up, rather than repeat presentation to the acute care setting. For those indicated for ACDF after presentation to the ED with myelopathy, a higher rate of re-admission was observed compared to the outpatient group. Further investigation is required to identify pre-operative and post-operative interventions to prevent readmission in this population

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Cervical Spine Research Society 51st Annual Meeting, November 29 - December 2, 2023, Las Vegas, NV