A comparison of readmission and complication rates and charges of inpatient and outpatient multiple-level anterior cervical discectomy and fusion surgeries in the Medicare population

Abstract

<jats:sec><jats:title>OBJECTIVE</jats:title><jats:p>This study aims to assess the relationship of comorbidities and postoperative complications to rates of readmission for geriatric patients undergoing anterior cervical discectomy and fusion (ACDF) involving more than 2 levels on an inpatient or outpatient basis. With the rising costs of healthcare in the United States, understanding the safety and efficacy of performing common surgical interventions (including ACDF) as outpatient procedures could prove to be of great economic impact.Objective This study aims to assess the effect of comorbidities and postoperative complications on the rates of readmission of geriatric patients undergoing multilevel anterior cervical discectomy and fusion (ACDF) procedures (i.e., ACDF involving 3 or more levels) on an inpatient or outpatient basis. Same-day surgery has been demonstrated to be a safe and cost-effective alternative to the traditional inpatient option for many surgical interventions. With the rising costs of healthcare, understanding the safety and efficacy of performing common surgical interventions as outpatient procedures could prove to be of great economic impact.</jats:p></jats:sec><jats:sec><jats:title>METHODS</jats:title><jats:p>The study population included total of 2492 patients: 2348 inpatients and 144 outpatients having ACDF procedures involving 3 or more levels in the Medicare Standard Analytical Files database. Age, sex, comorbidities, postoperative complications, readmission rates, and surgical procedure charges were compared between both cohorts. For selected variables, logistic regression was used to model odds ratios for various comorbidities against readmission rates for both inpatient and outpatient cohorts. Chi-square tests were also calculated to compare these comorbidities with readmission in each cohort.</jats:p></jats:sec><jats:sec><jats:title>RESULTS</jats:title><jats:p>Overall complication rates within 30 postoperative days were greater for inpatients than for outpatients (44.2% vs 12.5%, p &lt; 0.001). More inpatients developed postoperative urinary tract infection (7.9% vs 0%, p &lt; 0.001), and the inpatient cohort had increased risk of readmission with comorbidities of anemia (OR 1.52, p &lt; 0.001), smoking (OR 2.12, p &lt; 0.001), and BMI ≥ 30 (OR 1.43, p &lt; 0.001). Outpatients had increased risk of readmission with comorbidities of anemia (OR 2.78, p = 0.047), diabetes mellitus type 1 or 2 (OR 3.25, p = 0.033), and BMI ≥ 30 (OR 3.95, p = 0.008). Inpatients also had increased readmission risk with a postoperative complication of surgical site infection (OR 2.38, p &lt; 0.001). The average charges for inpatient multilevel ACDF were significantly higher than for multilevel ACDF performed on an outpatient basis ($12,734.27 vs $12,152.18, p = 0.0019).</jats:p></jats:sec><jats:sec><jats:title>CONCLUSIONS</jats:title><jats:p>This study suggests that ACDF surgery involving 3 or more levels performed as an outpatient procedure in the geriatric population may be associated with lower rates of readmissions, complications, and surgical charges.</jats:p></jats:sec>

The impact of the COVID‐19 pandemic on alloplastic breast reconstruction: An analysis of national outcomes

“…While these outcomes were rare and not individually significant, decreases in venous thromboses and thromboembolic events with outpatient operations have been shown with other surgical procedures when performed in the outpatient setting compared to inpatient and may be attributable to early mobilization. 14 , 45 , 46 …”

American Society of Anesthesiologists Physical Status Classification as a reliable predictor of postoperative medical complications and mortality following ambulatory surgery: an analysis of 2,089,830 ACS-NSQIP outpatient cases

“…Our results suggest that the ambulatory setting may not be able to match the needs of high-risk patients. These patients are probably better suited for surgery in the inpatient setting where close monitoring, potent IV medications and nursing care are readily available during the postoperative period [ 18 , 19 ].…”

Outpatient Versus Inpatient Anterior Lumbar Spine Surgery: A Multisite, Comparative Analysis of Patient Safety Measures

“…Several studies have compared ASC anterior cervical fusion or disc replacement with inpatient cohorts. [8][9][10][14][15][16][17][18][19][20] While there are also numerous reports on the safety of ASC posterior, [21][22][23][24][25][26] anterior, 13 and lateral lumbar spinal surgery, 27,28 there are very few ASC inpatient comparison studies for lumbar spine surgery. Emami and colleagues compared inpatient and ASC single-and two-level minimally invasive surgical transforaminal lumbar interbody fusion procedures, reporting similar outcomes with a slightly lower readmission rate for the ASC cohort.…”

“…A retrospective comparison of single-level cervical artificial disc replacement (ADR) performed in ASCs versus inpatient settings revealed no difference in the rates of readmission, reoperation, or complications, 7 while other reports have demonstrated lower readmission rates in the ASC cohort. [8][9][10] The safety of 231 single-and multilevel cervical disc replacements performed in 147 patients in an ASC setting with minimal complications or readmissions was recently reported. 11 The authors are aware of only one study directly comparing the safety of anterior lumbar spine surgery performed in a free-standing ASC setting with an inpatient hospital setting, which reported on 62 patients undergoing a single-level anterior lumbar interbody fusion (ALIF) at L5-S1 in an ASC (n ¼ 29) or hospital (n ¼ 33).…”