Can anterior cervical diskectomy/fusion (ACDF) be safely performed in ambulatory surgical centers (ASC's)?

Background: Can anterior cervical diskectomy/fusion (ACDF) be safely performed in ambulatory surgical centers (ASC's: i.e. discharges 4-7.5 hr. postoperatively) that meet the following stringent "exclusion criteria"; elevated Body Mass Index (BMI), major comorbidities, age > 65, American Society of Anesthesiology (ASA) scores > II, and largely multilevel ACDF. Materials: Presently, most ACDF are still being performed in hospital-based outpatient surgical centers (HBSC: utilizing 23-hour stays), or as inpatients. Results: Notably, unreliable disparate study designs involving very different patient populations resulted in nearly comparable, but implausible outcomes for 1-level vs. multilevel ACDF series performed in ASC. A summary of these outcome data included the following rates of; i.e. postoperative hospital transfers (0-6%), 30-day (up to 2.2%), and up to 90 day (2.2%) emergency department (ED) visits, readmissions, and reoperations. Conclusion: Nevertheless, it is just common sense that "less should be less", that 1-level ACDF should involve less risk compared with multilevel ACDF procedures performed in ASC.