in an ambuatory surgery center total cervical disc ......safety and reproducibility of total...

Safety and reproducibility of Total Cervical Disc Replacement in an Ambuatory Surgery Center

Nitin Khanna MD, FAAOSMichael Krzyskowski PA

www.nkspine.com

History of Spine Surgery

� Long procedures with high complication rate- “Don’t let anyone operate on your spine”

� Advanced technology and goal to improve outcomes with shorter recovery periods – key US surgeons leading minimally invasive spine surgery.

� Key concept – God built the patient better than I can fix them

Cervical Disc Replacement

� Replace cervical discs instead of fusing – Largest experiences in the Region

What are we doing now – Why?

● Most Surgeons still use over top cervical plates

● Adjacent segment disease and potential for constriction of the esophagus are at higher risk

● Compare to zero-profile ACDF

Case Example

● 50 year old male ○ 3 months neck

pain, arm pain and weakness

2 weeks postop

● Same day stay in hospital○ Taking 1 Norco every 6

hours● Arm pain resolved - neck

soreness● Soft collar for 2 weeks only● Released to work without

restrictions at 2 weeks

Patient Selection

� Must ensure that the patient is motivated to improve – the best surgery in the wrong patient will not work

� Focus on one level and ensure the other segments are in excellent condition

Methods

� Single surgeon, single center

� Retrospective Chart review� 16 one-level disc replacement, 2 two-level replacements

� 18 consecutive patients� Demographics

� Age, sex, BMI, third party payer

� PACU time

� Comorbidities

� 30 day readmission, infection, blood transfusion

Results

� Demographics� Average age 45.6 (33-57)� 12 male, 6 female� Average BMI 30.0 (23.0-43.1)� 12 private insurance, 6 worker’s compensation

� Comorbidities:� HTN (8), GERD (5), ex-smoker (5), hypothyroidism (4), smoker

(2)� 7 w/ sole comorbidity of: leukemia, h/o esophageal cancer, h/o heart

murmur, h/o hepatitis C infection, glaucoma, arthiritis, diabetes� Average length of stay - 93.9 minutes (54-133)� No infections were noted, no patients required a blood

transfusion or 30-day readmit

Conclusions

� Based on our small data set –Cervical Disc Replacement is safe and reliable procedure in the ambulatory surgery center setting

� Further multicenter studies need to be performed to confirm that this a generalizable findings as all the cases were performed by the senior author

� Patient selection and excellent workflow across disciplines in the Ambulatory surgery center are key to reproducible and safe results.

May 2019 -

� Disc replacement length of stay < 1 day

� No significant difference:� Readmit rate� perioperative adverse � events

� Single level TDR is safe in the outpatient setting

Thank you

Thank you

Questions?

Nitin Khanna, MDMichael Krzyskowski, PA-Cwww.nkspine.comwww.osni.org