Outpatient Lumbar Microdiscectomy: A Prospective Study in 122 Patients

Singhal, Ash; Bernstein, Mark

doi:10.1017/s031716710000202x

Cited by 54 publications

(44 citation statements)

References 25 publications

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“…13 The safety and effectiveness of outpatient lumbar spine surgery has been reported in numerous studies dating back as far as early 1990s. [1][2][3]11,14,19 However, the reports on safety of ACDF as an outpatient procedure are scarce. One of the major contributing factors to reluctance to perform ACDF in the outpatient setting is the potential complication of airway compromise due to airway swelling or postoperative hematoma.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3]11,14,19 Surgical costs to the health care provider, the third-party payer, and the health care purchaser are less in the ASC setting, but these cost savings will only be realized across the care episode if the ASC setting provides equivalent (or superior) surgical quality. Therefore, the demonstration of equivalent surgical safety and quality is necessary to determine the relative value (quality/cost) of outpatient versus inpatient ACDF.…”

mentioning

confidence: 99%

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Quality analysis of anterior cervical discectomy and fusion in the outpatient versus inpatient setting: analysis of 7288 patients from the NSQIP database

McGirt

Godil²,

Asher

et al. 2015

FOC

112

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OBJECT In an era of escalating health care cost and universal pressure of improving efficiency and cost of care, ambulatory surgery centers (ASCs) have emerged as lower cost options for many surgical therapies. Anterior cervical discectomy and fusion (ACDF) is one of the most prevalent spine surgeries performed and is rapidly increasing with an expanding aging population. While ASCs offer cost advantages for ACDF, there is a scarcity of evidence that ASCs allow for equivalent quality and thus superior health care value. Therefore, the authors analyzed a nationwide, prospective quality improvement registry (National Surgical Quality Improvement Program [NSQIP]) to compare the quality of ACDF surgery performed in the outpatient ASC versus the inpatient hospital setting. METHODS Patients undergoing ACDF (2005-2011) were identified from the NSQIP database based on the primary Current Procedural Terminology codes. Patients were divided into 2 cohorts (outpatient vs inpatient) based on the acute care setting documented in the NSQIP database. All 30-day surgical morbidity and mortality rates were compared between the 2 groups. Propensity score matching and multivariate logistic regression analysis were used to adjust for confounding factors and to identify the independent association of outpatient ACDF with perioperative outcomes and morbidity. RESULTS A total of 7288 ACDF cases were identified (inpatient = 6120, outpatient = 1168). Unadjusted rates of major morbidity (0.94% vs 4.5%, p < 0.001) and return to the operating room (OR) within 30 days (0.3% vs 2.0%, p < 0.001) were significantly lower in outpatient versus inpatient ACDF. After propensity matching 1442 cases (inpatient = 650, outpatient = 792) based on baseline 32 covariates, rates of major morbidity (1.4% vs 3.1%, p = 0.03), and return to the OR (0.34% vs 1.4%, p = 0.04) remained significantly lower after outpatient ACDF. Adjusted comparison using multivariate logistic regression demonstrated that ACDF performed in the outpatient setting had 58% lower odds of having a major morbidity and 80% lower odds of return to the OR within 30 days. CONCLUSIONS An analysis of a nationwide, prospective quality improvement registry representing more than 250 hospitals demonstrates that 1- to 2-level ACDF can be safely performed in the outpatient ambulatory surgery setting in patients who are appropriate candidates. In an effort to decrease cost of care, surgeons can safely consider performing ACDF in an ASC environment.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Quality analysis of anterior cervical discectomy and fusion in the outpatient versus inpatient setting: analysis of 7288 patients from the NSQIP database

McGirt

Godil²,

Asher

et al. 2015

FOC

112

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“…6,8,10,18 Evidence is growing that supports the safety and effectiveness of ASCs for lumbar decompression and discectomy; however, evidence for the safety and value of outpatient ACDF remains scarce. [1][2][3]16,20,25 Although short-term costs to health care providers, third-party payers, and health care purchasers tend to be lower in ASCs, cost savings will only be realized across the entire outpatient care episode if that care is associated with surgical safety on par with safety in inpatient settings. Cheaper surgical care up front will lose its value if associated with decreased safety and elevated downstream costs of complications and readmissions.…”

mentioning

confidence: 99%

Anterior cervical discectomy and fusion in the outpatient ambulatory surgery setting compared with the inpatient hospital setting: analysis of 1000 consecutive cases

Adamson

Godil

Mehrlich

et al. 2016

SPI

142

125

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OBJECTIVE In an era of escalating health care costs and pressure to improve efficiency and cost of care, ambulatory surgery centers (ASCs) have emerged as lower-cost options for many surgical therapies. Anterior cervical discectomy and fusion (ACDF) is one of the most prevalent spine surgeries performed, and the frequency of its performance is rapidly increasing as the aging population grows. Although ASCs offer significant cost advantages over hospital-based surgical centers, concern over the safety of outpatient ACDF has slowed its adoption. The authors intended to 1) determine the safety of the first 1000 consecutive ACDF surgeries performed in their outpatient ASC, and 2) compare the safety of these outpatient ACDFs with that of consecutive ACDFs performed during the same time period in the hospital setting. METHODS A total of 1000 consecutive patients who underwent ACDF in an ACS (outpatient ACDF) and 484 consecutive patients who underwent ACDF at Vanderbilt University Hospital (inpatient ACDF) from 2006 to 2013 were included in this retrospective study of patients' medical records. Data were collected on patient demographics, comorbidities, operative details, and perioperative and 90-day morbidity. Perioperative morbidity and hospital readmission were compared between the outpatient and inpatient ACDF groups. RESULTS Of the first 1000 outpatient ACDF cases performed in the authors' ASC, 629 (62.9%) were 1-level and 365 (36.5%) were 2-level ACDFs. Mean patient age was 49.5 ± 8.6, and 484 (48.4%) were males. All patients were observed postoperatively at the ASC postanesthesia care unit (PACU) for 4 hours before being discharged home. Eight patients (0.8%) were transferred from the surgery center to the hospital postoperatively (for pain control [n = 3], chest pain and electrocardiogram changes [n = 2], intraoperative CSF leak [n = 1], postoperative hematoma [n = 1], and profound postoperative weakness and surgical reexploration [n = 1]). No perioperative deaths occurred. The 30-day hospital readmission rate was 2.2%. All 90-day surgical morbidity was similar between outpatient and inpatient cohorts for both 1-level and 2-level ACDFs. CONCLUSIONS An analysis of 1000 consecutive patients who underwent ACDF in an outpatient setting demonstrates that surgical complications occur at a low rate (1%) and can be appropriately diagnosed and managed in a 4-hour ASC PACU window. Comparison with an inpatient ACDF surgery cohort demonstrated similar results, highlighting that ACDF can be safely performed in the outpatient ambulatory surgery setting without compromising surgical safety. In an effort to decrease costs of care, surgeons can safely perform 1- and 2-level ACDFs in an ASC environment.

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“…2,10 The acute complication rate of microdiscectomy from large series is from 1.5% to 15.8%. 7 Our results for both groups fall into this range.…”

Section: Discussionmentioning

confidence: 99%

Admission and Acute Complication Rate for Outpatient Lumbar Microdiscectomy

Fallah

Massicotte

Fehlings

et al. 2010

Can. j. neurol. sci.

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Specialization is generally independently associated with improved outcomes for all types of surgery.1-2 This is primarily attributed to specialized surgeons being more likely to perform higher volumes of select procedures. 1 Degenerative disc disease of the lumbar spine is a prevalent and costly ailment that often requires surgical intervention.3 A significant number of patients have further reoperations [14%] or develop failed back syndrome [8-25%] which is failure to improve satisfactorily following surgery. [4][5][6] Unsuccessful operations are largely attributed to incomplete discectomy, nerve ABSTRACT: Objective: Specialization is generally independently associated with improved outcomes for most types of surgery. This is the first study comparing the immediate success of outpatient lumbar microdiscectomy with respect to acute complication and conversion to inpatient rate. Long term pain relief is not examined in this study. Methods: Two separate prospective databases (one belonging to a neurosurgeon and brain tumor specialist, not specializing in spine (NS) and one belonging to four spine surgeons (SS)) were retrospectively reviewed. All acute complications as well as admission data of patients scheduled for outpatient lumbar microdiscectomy were extracted. Results: In total, 269 patients were in the NS group and 137 patients were in the SS group. The NS group averaged 24 cases per year while the SS group averaged 50 cases per year. Chi-square tests revealed no difference in acute complication rate [NS(6.7%), SS(7.3%)] (p>0.5) and admission rate [NS(4.1%), SS(5.8%)] (p=0.4) while the SS group had a significantly higher proportion of patients undergoing repeat microdiscectomy [NS(4.1%), SS(37.2%)] (p<0.0001). Excluding revision operations, there was no statistically significant difference in acute complication [NS(5.4%), SS(1.2%)] (p=0.09) and conversion to inpatient [NS(4.3%), SS(4.6%)] (p>0.5) rate. The combined acute complication and conversion to inpatient rate was 6.9% and 4.7% respectively. Conclusion: Based on this limited study, outpatient lumbar microdiscectomy can be apparently performed safely with similar immediate complication rates by both non-spine specialized neurosurgeons and spine surgeons, even though the trend favored the latter group for both outcome measures. RÉSUMÉ: Hospitalisation et taux de complications aiguës chez les patients qui subissent une microdiscectomie lombaire en externe. Objectif :Spécialisation est généralement associée de façon indépendante à de meilleurs résultats dans la plupart des types de chirurgies. Il s'agit de la première étude comparant le taux de complications aiguës et l'hospitalisation pour évaluer le succès immédiat de la microdiscectomie lombaire en externe. Le soulagement de la douleur à long terme n'a pas été examiné dans cette étude. Méthodes : Nous avons révisé rétrospectivement deux bases de données prospectives (celle d'un neurochirurgien, spécialiste du traitement de tumeurs cérébrales, mais non pas de la colonne vertébrale (NS) et celle de 4 c...

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Outpatient Lumbar Microdiscectomy: A Prospective Study in 122 Patients

Cited by 54 publications

References 25 publications

Quality analysis of anterior cervical discectomy and fusion in the outpatient versus inpatient setting: analysis of 7288 patients from the NSQIP database

Quality analysis of anterior cervical discectomy and fusion in the outpatient versus inpatient setting: analysis of 7288 patients from the NSQIP database

Anterior cervical discectomy and fusion in the outpatient ambulatory surgery setting compared with the inpatient hospital setting: analysis of 1000 consecutive cases

Admission and Acute Complication Rate for Outpatient Lumbar Microdiscectomy

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