Comparison of Transforaminal Lumbar Interbody Fusion in the Ambulatory Surgery Center and Traditional Hospital Settings, Part 2: Assessment of Surgical Safety in Medicare Beneficiaries

Abstract

(1) Background: The clinical benefits and procedural efficiencies of performing minimally invasive fusion procedures, such as transforaminal lumbar interbody fusion (TLIF), in the ambulatory surgery center (ASC) are becoming increasingly well established. Currently, Medicare does not provide reimbursement for its beneficiaries eligible for TLIF in the ASC due to a lack of evidence regarding procedural safety. However, the initiation of the Hospital Without Walls program allowed for traditional hospital procedures to be relocated to other facilities such as ASCs, providing a unique opportunity to evaluate the utility of TLIF in the ASC in Medicare-age patients. (2) Methods: This single-center, retrospective study compared baseline characteristics, intraoperative variables, and 30-day postoperative safety outcomes between 48 Medicare-age patients undergoing TLIF in the ASC and 48 patients having the same procedure as hospital in-patients. All patients had a one-level TLIF using the VariLift®-LX expandable lumbar interbody fusion device. (3) Results: There were similar patient characteristics, procedural efficiency, and occurrence of clinical 30-day safety events between the two study groups. However, there was a marked and statistically significant difference in the median length of stay favoring TLIF patients treated in the ASC (23.9 h vs. 1.6 h, p = 0.001). All ASC-treated patients were discharged on the day of surgery. Postoperative visits to address adverse events were rare in either group. (4) Conclusions: These findings provide evidence that minimally invasive TLIF can be performed safely and efficiently in the ASC in Medicare-age patients. With same-day discharge, fusion procedures performed in the ASC offer a similar safety and more attractive cost–benefit profile for older patients than the same surgery undertaken in the traditional hospital setting. The Centers for Medicare and Medicaid Services should strongly consider extending the appropriate reimbursement codes (CPT ® 22630, 22633) for minimally invasive TLIF and PLIF to the ASC Covered Procedure List so that Medicare-age patients can realize the clinical benefits of surgeries performed in this setting.

Comparison of the Safety of Inpatient Versus Outpatient Lumbar Fusion

“…Twelve studies with a total of 70,106 IPS patients and 5135 OPS patients were included for surgical complications. 18,[20][21][22][23][24][25][26][28][29][30][31] The meta-analysis of 12 studies showed significantly decreased odds of surgical complication rates among OPS compared with IPS [OR = 0.41 (0.50-0.68), P = < 0.001, I2 = 37.9%] (Fig. 5).…”

Surgeon Perceptions of Performing Transforaminal Lumbar Interbody Fusion in an Ambulatory Surgical Center vs Hospital Setting in the Elderly Population: Results of a Surgeon Survey

“…4 The clinical benefits and procedural efficiencies of performing minimally invasive fusion procedures such as TLIF in the ASC setting are becoming increasingly well established, suggesting a growing recognition of the viability and effectiveness of ASCs for these types of surgical procedures. 5 Comparative studies evaluated differences in perioperative baseline characteristics, operative efficiency, and 30-day safety events for patients undergoing MIS-TLIF in a hospital vs an ASC and highlighted similar safety profiles and clinical outcomes in ASC compared with traditional hospital settings. [6][7][8][9] There is also a growing acceptance of performing MIS-TLIF in ASCs, indicating a shift in surgical practices toward more cost-effective and patient-friendly environments.…”