A non-inferiority analysis of surgical outcomes following outpatient laminoplasty for cervical spondylosis

Abstract

Objective

A trend of outpatient spinal procedures has recently been observed due to evidence of less hospital-associated risks and better value-based care. We aimed to assess non-inferiority in surgical outcomes of outpatient and inpatient laminoplasty for cervical spondylosis.

Methods

The American College of Surgeons National Surgical Quality Improvement Program database was queried for patients undergoing cervical laminoplasty for spinal spondylosis. Patients with a hospital stay longer than 48 hours were excluded to increase baseline comparability between groups. Patients undergoing other spinal procedures during the same hospital stay were also excluded. The outcomes of interest were postoperative complications, readmissions, and reoperations within 30 days postoperatively. The non-inferiority of outpatient compared to inpatient surgery was defined as a risk difference of < 10.0 % at a one-sided 97.5 % confidence interval.

Results

Total 808 cervical laminoplasty surgeries were identified. The study cohorts consisted of 107 and 701 patients in outpatient and inpatient groups, respectively. Baseline characteristics, except age (58.3 ± 10.6 vs. 61.4 ± 11.5 years, p = 0.01), were similar between groups. The incidences of postoperative complications were 2.8 % and 3.4 % for the outpatient and inpatient groups, respectively, while both groups had a 30-day readmission rate of 3.7 %. The 30-day reoperation rates were 2.8 % and 1.4 % for the outpatient and inpatient groups, respectively. Noninferiority of outpatient surgery was documented at a risk difference of 10 % for postoperative complications, readmissions, and reoperations.

Conclusions

Outpatient cervical laminoplasty demonstrated similar early postoperative outcomes to inpatient surgery, with non-inferiority documented in surgical outcomes. Therefore, outpatient laminoplasty can be safely offered in carefully selected patients with minimal perioperative risk factors. Future research should further refine patient selection criteria for outpatient procedures to optimize surgical decision-making.