The Impact of Surgeon Preference on Same-Day Discharge Following Anterior Cervical Discectomy and Fusion.

Introduction: Anterior cervical discectomy and fusion (ACDF) is a common procedure for cervical degenerative disc disease, with a growing shift toward outpatient surgery. Despite advancements enabling shorter hospital stays, same-day discharge remains a complex decision influenced by factors such as case timing and surgeon-specific practices. This study aims to identify patient and operational factors associated with same-day discharge following ACDF. Methods: We retrospectively analyzed all elective ACDF procedures performed by 24 different surgeons across 3 affiliated hospitals within a large urban health system between January 2021 and December 2022. Patient and clinical factors, case timing, and surgeon-specific practices were compared between patients who received same-day discharge and those who were admitted on the same day following ACDF. Results: Among the 530 elective ACDF procedures analyzed, 18.5% resulted in same-day discharge. Same-day discharge occurred significantly more frequently in procedures involving fewer operative levels, no surgical drain, and lower estimated blood loss (EBL). In contrast, factors such as age, Charlson Comorbidity Index, American Society of Anesthesiologists score, and preoperative antiplatelet or anticoagulation use did not significantly impact discharge rates. Earlier case completion times were strongly associated with same-day discharge, with 69.4% of such discharges occurring in cases completed before 14:00. Surgeon preference emerged as a key determinant, with the 15 surgeons who performed 10 or more procedures falling into 3 distinct categories: those who never, rarely, or routinely discharged patients on the same day. Conclusions: Surgeon preference plays a critical role in shaping discharge decisions following ACDF. Alongside case complexity, EBL, drain usage, and timing, surgeon preference strongly influences whether a patient is discharged on the same day. Identifying and understanding the concerns underlying variable surgeon practice patterns will help promote standardization of discharge criteria, optimize selection for same-day discharge, and improve healthcare resource utilization.