National Trends in Outpatient Surgical Treatment of Degenerative Cervical Spine Disease

Abstract

Study Design Retrospective population-based observational study. Objective To assess the growth of cervical spine surgery performed in an outpatient setting. Methods A retrospective study was conducted using the United States Healthcare Cost and Utilization Project's State Inpatient and Ambulatory Surgery Databases for California, New York, Florida, and Maryland from 2005 to 2009. Current Procedural Terminology, fourth revision (CPT-4) and International Classification of Diseases, ninth revision Clinical Modification (ICD-9-CM) codes were used to identify operations for degenerative cervical spine diseases in adults (age > 20 years). Disposition and complication rates were examined. Results There was an increase in cervical spine surgeries performed in an ambulatory setting during the study period. Anterior cervical diskectomy and fusion accounted for 68% of outpatient procedures; posterior decompression made up 21%. Younger patients predominantly underwent anterior fusion procedures, and patients in the eighth and ninth decades of life had more posterior decompressions. Charlson comorbidity index and complication rates were substantially lower for ambulatory cases when compared with inpatients. The majority (>99%) of patients were discharged home following ambulatory surgery. Conclusions Recently, the number of cervical spine surgeries has increased in general, and more of these procedures are being performed in an ambulatory setting. The majority (>99%) of patients are discharged home but the nature of analyzing administrative data limits accurate assessment of postoperative complications and thus patient safety. This increase in outpatient cervical spine surgery necessitates further discussion of its safety.

Rates of Mortality in Cervical Spine Surgical Procedures and Factors Associated With Its Occurrence Over a 10-Year Period: A Study of 342 477 Patients on the Nationwide Inpatient Sample

“…The NIS database design also prevents the capture of mortality rates for outpatient cervical spine procedures, which are being performed with increasing frequency. 26 It may underestimate overall mortality for this reason 1,9 but is likely accurate in the context of elective cervical procedures.…”

Safety and Efficiency of Cervical Disc Arthroplasty in Ambulatory Surgery Centers vs. Hospital Settings

“…Bolstered by trends toward less invasive surgery, as well as modified anesthetic and pain management techniques, surgical procedures are increasingly performed as outpatient procedures across all surgical fields. 1 Concomitantly, ambulatory surgery centers (ASCs) have rapidly multiplied in the United States, so that outpatient surgeries are increasingly performed in an ASC. 2,3 Similarly in relatively healthy patients, spine surgery has increasingly been performed in outpatient settings including ASCs since the 1980s.…”

“…2,3 Similarly in relatively healthy patients, spine surgery has increasingly been performed in outpatient settings including ASCs since the 1980s. 1,4 Surgeons have analyzed spinal surgeries performed in patient cohorts ranging in size from less than 100 to over 1000 patients. [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20] Furthermore, the comparative safety and effectiveness of spine surgery performed on an outpatient versus inpatient basis have been evaluated for a variety of procedures: lumbar discectomy, 21,22 lumbar decompression, 23,24 lumbar interbody fusion, 25,26 anterior cervical discectomy and fusion (ACDF), [27][28][29][30][31][32] and cervical disc arthroplasty (CDA).…”

Spine Surgery in an Ambulatory Setting: What Can Be Done Safely?

“…As one would expect, this trend has occurred in spine surgery as well 4,8 . Spine surgery is particularly appealing to ambulatory surgery centers as it represents an area of remarkable growth and profit.…”