{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T16:38:35Z","timestamp":1777480715502,"version":"3.51.4"},"reference-count":27,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2019,2,21]],"date-time":"2019-02-21T00:00:00Z","timestamp":1550707200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Anterior cervical discectomy and fusion (ACDF) is the standard surgical management for disc herniation and spondylosis worldwide and reportedly performed with short hospitalization and early discharge (ED). However, it is unknown if ED improves the outcomes of ACDF including among older adults. This cohort study included patients who underwent ACDF surgery in Taiwan over two years analyzed in two groups: the ED group (discharged within 48 hours), and the comparison group (hospitalized for more than 48 h). Both groups were followed-up for at least 180 days. Pre- and post-operative comorbidities, re-admissions and re-operations were analyzed using a multivariate cox-regression model, with bootstrapping, and Kaplan\u2013Meier analysis. Among 5565 ACDF patients, the ED group (n = 405) had a higher chance (crude and adjusted hazard ratio = 2.33 and 2.39, both p &lt; 0.001) of re-admission than the comparison group (n = 5160). The ED group had an insignificant trend toward more re-admissions for spinal problems and re-operations within 180 days. In the ED group, older age (\u226560) and hypertension were predictive of re-admission. For ACDF surgery, the ED group had higher rates of re-admission within 180 days of post-op, suggesting that the current approach to ED requires modification or more cautious selection criteria be adopted, particularly for older adults.<\/jats:p>","DOI":"10.3390\/ijerph16040641","type":"journal-article","created":{"date-parts":[[2019,2,22]],"date-time":"2019-02-22T03:49:44Z","timestamp":1550807384000},"page":"641","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Early Discharge for Anterior Cervical Fusion Surgery: Prediction of Readmission and Special Considerations for Older Adults"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4124-1949","authenticated-orcid":false,"given":"Yu-Chun","family":"Chen","sequence":"first","affiliation":[{"name":"Department of Family Medicine, School of Medicine, National Yang-Ming University, Taipei 11221, Taiwan"},{"name":"Department of Family Medicine, Taipei Veterans\u2019 General Hospital, Taipei 11217, Taiwan"},{"name":"Institute of Hospital and Health Care Administration, National Yang-Ming University, Taipei 11221, Taiwan"},{"name":"Department of Biomedical Engineering, School of Biomedical Science and Engineering, National Yang-Ming University, Taipei 11221, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6996-3409","authenticated-orcid":false,"given":"Jau-Ching","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, School of Medicine, National Yang-Ming University, Taipei 11221, Taiwan"},{"name":"Department of Neurosurgery, Neurological Institute, Taipei Veterans\u2019 General Hospital, Taipei 11217, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hsuan-Kan","family":"Chang","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, School of Medicine, National Yang-Ming University, Taipei 11221, Taiwan"},{"name":"Department of Neurosurgery, Neurological Institute, Taipei Veterans\u2019 General Hospital, Taipei 11217, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wen-Cheng","family":"Huang","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, School of Medicine, National Yang-Ming University, Taipei 11221, Taiwan"},{"name":"Department of Neurosurgery, Neurological Institute, Taipei Veterans\u2019 General Hospital, Taipei 11217, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2019,2,21]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"577","DOI":"10.3171\/2016.10.SPINE16317","article-title":"Is cervical disc arthroplasty good for congenital cervical stenosis?","volume":"26","author":"Chang","year":"2017","journal-title":"J. Neurosurg. Spine"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"627","DOI":"10.1007\/s00586-013-3123-8","article-title":"Differences between arthroplasty and anterior cervical fusion in two-level cervical degenerative disc disease","volume":"23","author":"Fay","year":"2014","journal-title":"Eur. Spine J."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1055\/s-0031-1298610","article-title":"Cervical artificial disc replacement versus fusion in the cervical spine: A systematic review comparing long-term follow-up results from two FDA trials","volume":"3","author":"Mummaneni","year":"2012","journal-title":"Evid. Based Spine Care J."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"594","DOI":"10.3171\/2012.2.SPINE111066","article-title":"Differences between 1- and 2-level cervical arthroplasty: More heterotopic ossification in 2-level disc replacement: Clinical article","volume":"16","author":"Wu","year":"2012","journal-title":"J. Neurosurg. Spine"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"163","DOI":"10.3171\/2011.10.SPINE11497","article-title":"Differences between soft-disc herniation and spondylosis in cervical arthroplasty: CT-documented heterotopic ossification with minimum 2 years of follow-up","volume":"16","author":"Wu","year":"2012","journal-title":"J. Neurosurg. Spine"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"963","DOI":"10.1227\/01.neu.0000303192.64802.c6","article-title":"Multilevel anterior cervical fusion using a collagen-hydroxyapatite matrix with iliac crest bone marrow aspirate: An 18-month follow-up study","volume":"61","author":"Khoueir","year":"2007","journal-title":"Neurosurgery"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"413","DOI":"10.1097\/00006123-200208000-00020","article-title":"Polylactic acid mesh reconstruction of the anterior iliac crest after bone harvesting reduces early postoperative pain after anterior cervical fusion surgery","volume":"51","author":"Wang","year":"2002","journal-title":"Neurosurgery"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"135","DOI":"10.1227\/01.NEU.0000163427.42536.A7","article-title":"Resorbable polylactic acid interbody spacers with vertebral autograft for anterior cervical discectomy and fusion","volume":"57","author":"Wang","year":"2005","journal-title":"Neurosurgery"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"521","DOI":"10.3171\/spi.2005.2.5.0521","article-title":"Anterior cervical discectomy and fusion involving a polyetheretherketone spacer and bone morphogenetic protein","volume":"2","author":"Boakye","year":"2005","journal-title":"J. Neurosurg. Spine"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"280","DOI":"10.3171\/2014.12.SPINE14545","article-title":"Two-level corpectomy versus three-level discectomy for cervical spondylotic myelopathy: A comparison of perioperative, radiographic, and clinical outcomes","volume":"23","author":"Lau","year":"2015","journal-title":"J. Neurosurg. Spine"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"529","DOI":"10.3171\/SPI\/2008\/8\/6\/529","article-title":"The safety and efficacy of anterior cervical discectomy and fusion with polyetheretherketone spacer and recombinant human bone morphogenetic protein-2: A review of 200 patients","volume":"8","author":"Tumialan","year":"2008","journal-title":"J. Neurosurg. Spine"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"466","DOI":"10.1016\/j.clnu.2005.02.002","article-title":"Enhanced recovery after surgery: A consensus review of clinical care for patients undergoing colonic resection","volume":"24","author":"Fearon","year":"2005","journal-title":"Clin. Nutr."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"961","DOI":"10.1001\/archsurg.2009.170","article-title":"Consensus review of optimal perioperative care in colorectal surgery: Enhanced Recovery After Surgery (ERAS) Group recommendations","volume":"144","author":"Lassen","year":"2009","journal-title":"Arch. Surg."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"434","DOI":"10.1016\/j.clnu.2010.01.004","article-title":"The enhanced recovery after surgery (ERAS) pathway for patients undergoing major elective open colorectal surgery: A meta-analysis of randomized controlled trials","volume":"29","author":"Varadhan","year":"2010","journal-title":"Clin. Nutr."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"878","DOI":"10.3171\/2015.8.SPINE14284","article-title":"Anterior cervical discectomy and fusion in the outpatient ambulatory surgery setting compared with the inpatient hospital setting: Analysis of 1000 consecutive cases","volume":"24","author":"Adamson","year":"2016","journal-title":"J. Neurosurg. Spine"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"3","DOI":"10.14444\/4003","article-title":"Outpatient Anterior Cervical Discectomy and Fusion: An Analysis of Readmissions from the New Jersey State Ambulatory Services Database","volume":"11","author":"McClelland","year":"2017","journal-title":"Int. J. Spine Surg."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"439","DOI":"10.1097\/BSD.0b013e3181bd0419","article-title":"Safety of anterior cervical discectomy and fusion performed as outpatient surgery","volume":"23","author":"Garringer","year":"2010","journal-title":"J. Spinal Disord. Tech."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"148","DOI":"10.1016\/j.spinee.2006.04.009","article-title":"The safety of instrumented outpatient anterior cervical discectomy and fusion","volume":"7","author":"Villavicencio","year":"2007","journal-title":"Spine J."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"594","DOI":"10.1227\/NEU.0b013e318232d4f2","article-title":"The incidence of adjacent segment disease requiring surgery after anterior cervical diskectomy and fusion: Estimation using an 11-year comprehensive nationwide database in Taiwan","volume":"70","author":"Wu","year":"2012","journal-title":"Neurosurgery"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"698","DOI":"10.1097\/MLR.0000000000000735","article-title":"Identifying Increased Risk of Readmission and In-hospital Mortality Using Hospital Administrative Data: The AHRQ Elixhauser Comorbidity Index","volume":"55","author":"Moore","year":"2017","journal-title":"Med. Care"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1130","DOI":"10.1097\/01.mlr.0000182534.19832.83","article-title":"Coding algorithms for defining comorbidities in ICD-9-CM and ICD-10 administrative data","volume":"43","author":"Quan","year":"2005","journal-title":"Med. Care"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"861","DOI":"10.1093\/bja\/aev257","article-title":"Challenges in postdischarge function and recovery: The case of fast-track hip and knee arthroplasty","volume":"115","author":"Aasvang","year":"2015","journal-title":"Br. J. Anaesth."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"245","DOI":"10.23736\/S0390-5616.16.03695-X","article-title":"A perspective on the use of an enhanced recovery program in open, non-instrumented day surgery for degenerative lumbar and cervical spinal conditions","volume":"62","author":"Venkata","year":"2018","journal-title":"J. Neurosurg. Sci."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1044","DOI":"10.1097\/BRS.0000000000001988","article-title":"Outpatient Anterior Cervical Discectomy and Fusion is Associated With Fewer Short-term Complications in One- and Two-level Cases: A Propensity-adjusted Analysis","volume":"42","author":"Fu","year":"2017","journal-title":"Spine"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"E9","DOI":"10.3171\/2015.9.FOCUS15335","article-title":"Quality analysis of anterior cervical discectomy and fusion in the outpatient versus inpatient setting: Analysis of 7288 patients from the NSQIP database","volume":"39","author":"McGirt","year":"2015","journal-title":"Neurosurg. 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