{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,13]],"date-time":"2025-11-13T06:37:06Z","timestamp":1763015826864},"reference-count":19,"publisher":"Scientific Scholar","content-domain":{"domain":["surgicalneurologyint.com"],"crossmark-restriction":true},"short-container-title":[],"abstract":"<jats:sec id=\"st1\">\n<jats:title>Background: <\/jats:title>\n<jats:p>This is an updated analysis of the morbidity and mortality of cervical surgery performed in outpatient\/same day (OSD) (Postoperative care unit [PACU] observation 4\u20136 h), and ambulatory surgicenters (ASC: PACU 23 h) versus inpatient facilities (IF).<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"st2\">\n<jats:title>Methods: <\/jats:title>\n<jats:p>We analyzed 19 predominantly level III (retrospective) and IV (case series) studies regarding the morbidity\/mortality of cervical surgery performed in OSC\/ASC versus IF.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"st3\">\n<jats:title>Results: <\/jats:title>\n<jats:p>A \u201cselection bias\u201d clearly favored operating on younger\/healthier patients to undergo cervical surgery in OSD\/ASC centers resulting in better outcomes. Alternatively, those selected for cervical procedures to be performed in IF classically demonstrated multiple major comorbidities (i.e. advanced age, diabetes, high body mass index, severe myelopathy, smoking, 3\u20134 level disease, and other comorbidities) and had poorer outcomes. Further, within the typical 4\u20136 h. PACU \u201cobservation window,\u201d OSD facilities \u201cpicked up\u201d most major postoperative complications, and typically showed 0% mortality rates. Nevertheless, the author\u2019s review of 2 wrongful death suits (i.e. prior to 2018) arising from OSD ACDF cervical surgery demonstrated that there are probably many more mortalities occurring following discharges from OSD where cervical operations are being performed that are going underreported\/unreported.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"st4\">\n<jats:title>Conclusion: <\/jats:title>\n<jats:p>\u201cSelection bias\u201d favors choosing younger\/healthier patients to undergoing cervical surgery in OSD\/ ASC facilities resulting in better outcomes. Atlernatively, choosing older patients with greater comorbidities for IF surgery correlated with poorer results. Although most OSD cervical series report 0% mortality rates, a review of 2 wrongful death suits by just one neurosurgeon prior to 2018 showed there are probably many more mortalities resulting from OSD cervical surgery than have been reported.<\/jats:p>\n<\/jats:sec>","DOI":"10.25259\/sni_509_2021","type":"journal-article","created":{"date-parts":[[2021,7,12]],"date-time":"2021-07-12T11:04:47Z","timestamp":1626087887000},"page":"349","update-policy":"http:\/\/dx.doi.org\/10.25259\/crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Perspective on morbidity and mortality of cervical surgery performed in outpatient\/same day\/ambulatory surgicenters versus inpatient 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