Comparison of Transforaminal Lumbar Interbody Fusion in the Ambulatory Surgery Center and Traditional Hospital Settings, Part 1: Multi-Center Assessment of Surgical Safety

Schlesinger, Scott; Gelber, Benjamin R.; Gerber, Mark B.; Lorio, Morgan P.; Block, Jon E.

doi:10.3390/jpm13020311

Cited by 2 publications

(3 citation statements)

References 24 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Eight studies with a total of 42,995 IPS patients and 3,593 OPS patients were included for readmission 18,20–22,25,27–29 . The Pooled readmission rate was 3.4% (0.7%–8.2%) in the OPS cohorts and 4.2% (1.6%–8%) in the IPS cohorts.…”

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Comparison of the Safety of Inpatient versus Outpatient Lumbar Fusion

Subramanian,

Akosman,

Amen

et al. 2023

Spine

View full text Add to dashboard Cite

Study Design. Systematic Review and Meta-Analysis Objective. The objective of this study is to synthesize the early data regarding and analyze the safety profile of outpatient lumbar fusion. Summary of Background Data. Preforming lumbar fusion in an outpatient or ambulatory setting is becoming an increasingly employed strategy to provide effective value-based care. As this is an emerging option for surgeons to employ in their practices, the data is still in its infancy. Methods. This study was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies that described outcomes of inpatient and outpatient lumbar fusion cohorts were searched from PubMed, Medline, The Cochrane Library, and Embase. Rates of individual medical and surgical complications, readmission, and reoperation were collected when applicable. Patient reported outcomes were additionally collected if reported. Individual pooled comparative meta-analysis was performed for outcomes of medical complications, surgical complications, readmission, and reoperation. Patient reported outcomes were reviewed and qualitatively reported. Results. The search yielded 14 publications that compared outpatient and inpatient cohorts with a total of 75,627 patients. Odds of readmission demonstrated no significant difference between outpatient and inpatient cohorts (OR=0.94 [0.81 - 1.11]). Revision surgery similarly was no different between the cohorts (OR=0.81 [0.57 - 1.15]). Pooled medical and surgical complications demonstrated significantly decreased odds for outpatient cohorts compared to inpatient cohorts (OR=0.58 [0.34 - 0.50], OR=0.41 [0.50 - 0.68] respectively). Patient reported outcome measures were largely the same between the cohorts when reported, with few studies showing better ODI and VAS-Leg outcomes among outpatient cohorts compared to inpatient cohorts. Conclusion. Preliminary data regarding the safety of outpatient lumbar fusion demonstrates a favorable safety profile in appropriately selected patients, with patient reported outcomes remaining comparable in this setting. There is no data in the form of prospective and randomized trials which is necessary to definitively change practice.

show abstract

Section: Resultsmentioning

confidence: 99%

“…4). Twelve studies with a total of 70,106 IPS patients and 5135 OPS patients were included for surgical complications 18,20–26,28–31 . 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.…”

Section: Resultsmentioning

confidence: 99%

Comparison of the Safety of Inpatient versus Outpatient Lumbar Fusion

Subramanian,

Akosman,

Amen

et al. 2023

Spine

View full text Add to dashboard Cite

show abstract

“…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. This trend is partly facilitated by certain technological advancements, such as navigation and robotics, which facilitate MIS-TLIF in outpatient settings.…”

Section: Introductionmentioning

confidence: 99%

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

Lewandrowski,

Alhammoud,

Schlesinger

et al. 2024

Int J Spine Surg

View full text Add to dashboard Cite

Background: There is an increasing acceptance of conducting minimally invasive transforaminal lumbar interbody fusion (TLIF) in ambulatory surgical centers (ASCs). The Centers for Medicare and Medicaid Services (CMS) introduced the Hospitals Without Walls (HWW) program in March 2020. This program granted hospitals regulatory flexibility to offer services and procedures in nontraditional locations, including ASCs. However, implementation hurdles persist.Methods: A survey was sent to 235 surgeons regarding the use of ASCs for performing TLIF surgeries on elderly patients. Multiple-choice questions covering various aspects of TLIF practice preferences, including surgical indications, decision factors for choosing ASCs over hospitals, implementation hurdles, reimbursement concerns, staffing issues, and the impact of CMS rules and regulations on TLIF in ASCs, particularly concerning physician ownership and self-referral conflicts governed by the Stark law, were asked.Results: The survey completion rate was 25.8% (Figure 1). The most common surgical indications for TLIF in ASCs were spondylolisthesis (80%), spinal stenosis (62.5%), and low back pain (47.5%). Most surgeons (78%) believed TLIF could be safely performed in ASCs. Streamlined workflow, lower infection rates, and cost-effectiveness were advantages listed by 58.5% of surgeons. Patient's medical history (75.8%), followed by ASC resources and capabilities (61%) and surgeon preference (61%), were relevant factors. Higher efficiencies at ASCs (14.6%), contractual issues (9.8%), and ownership issues (7.3%) were less relevant to surgeons. About 65.9% of surgeons reported lower reimbursement in ASCs, and 43.9% said it was an implementation hurdle. Lower direct costs were reported by 53.7% of surgeons. Other hurdles included a lack of trained staff (24.4%), inadequate staffing (22.0%), cost overruns (26.8%), high Joint Commission or the Accreditation Association for Ambulatory Health Care credentialing costs, and surgeons feeling uncomfortable performing TLIF in ASCs (22.0%). Only 17.1% listed medical problems as a reason their patient was considered unsuitable for the ASC environment. A majority (53.7%) stated that their ASCs complied with strict Stark requirements by disclosing physician ownership interests. However, 22% of surgeons reported self-referrals under the "In-Office Ancillary Services Exception" allowed by the Stark law.Conclusion: Our survey data show that surgeons' perceptions of current CMS rules and regulations may hinder the transition into the ASC setting because they think the reimbursement is too low and the regulatory burden is too high. ASCs have disproportionally higher initial acquisition and ongoing costs related to staff training and maintenance of the TLIF technology that CMS should consider when determining the appropriate financial remuneration for these complex procedures.Clinical Relevance: ASC offers a viable and attractive option for their TLIF procedure with the advantage of same-day discharge and at-home recovery.

show abstract

Comparison of Transforaminal Lumbar Interbody Fusion in the Ambulatory Surgery Center and Traditional Hospital Settings, Part 1: Multi-Center Assessment of Surgical Safety

Cited by 2 publications

References 24 publications

Comparison of the Safety of Inpatient versus Outpatient Lumbar Fusion

Comparison of the Safety of Inpatient versus Outpatient Lumbar Fusion

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

Contact Info

Product

Resources

About