Safety of outpatient <i>vs.</i> inpatient anterior cervical discectomy and fusion: a systematic review and meta-analysis
Bibliographic record
Abstract
Objective: To evaluate and compare the safety of outpatient and inpatient anterior cervical discectomy and fusion (ACDF) regarding complications and related outcomes. Methods: PubMed, Embase, and Scopus were systematically searched for retrospective cohort studies published between January 1, 2000, and December 31, 2024, comparing outpatient and inpatient ACDF. Pooled relative risks (RRs) and weighted mean differences (WMDs) were calculated using a random-effects model. Study quality and certainty of evidence were assessed using the Newcastle-Ottawa Scale (NOS) and GRADE, respectively. Results: A total of 21 studies involving 164,541 patients (36,361 outpatient and 128,180 inpatient) were included. Outpatient ACDF resulted in significantly lower incidence of overall complications (RR 0.45, 95% CI [0.35-0.57]), mortality (RR 0.35, 95% CI [0.16-0.77]), deep vein thrombosis (RR 0.56, 95% CI [0.37-0.85]), and wound complications (RR 0.59, 95% CI [0.52-0.68]). Reduced risks were also observed for unplanned reoperations (RR 0.33, 95% CI [0.24-0.46]), readmissions (RR 0.57, 95% CI [0.46-0.70]), and pulmonary complications (RR 0.43, 95% CI [0.27-0.68]). Risks of stroke, dysphagia, hematoma, and renal and cardiac complications were comparable between the groups. The certainty of evidence was rated low to very low due to high heterogeneity, retrospective study designs, and indirectness. Conclusion: Outpatient ACDF is associated with fewer complications as compared to inpatient procedures for carefully selected patients. However, the retrospective nature of the studies, the possibility of selection bias, and low-certainty evidence underscore the need for high-quality prospective research to validate these results and inform clinical practice.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.017 | 0.045 |
| Meta-epidemiology (narrow) | 0.003 | 0.002 |
| Meta-epidemiology (broad) | 0.021 | 0.040 |
| Bibliometrics | 0.005 | 0.006 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.003 | 0.002 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".