Recoup From Home? Comparison of Relative Cost Savings for ACDF, Lumbar Discectomy, and Short Segment Fusion Performed in the Inpatient Versus Outpatient Setting

Abstract

Study Design: Broad narrative review. Objective: To review and summarize the current literature on the cost efficacy of performing ACDF, lumbar discectomy and short segment fusions of the lumbar spine performed in the outpatient setting. Methods: A thorough review of peer- reviewed literature was performed on the relative cost-savings, as well as guidelines, outcomes, and indications for successfully implementing outpatient protocols for routine spine procedures. Results: Primary elective 1-2 level ACDF can be safely performed in most patient populations with a higher patient satisfaction rate and no significant difference in 90-day reoperations and readmission rates, and a savings of 4000 to 41 305 USD per case. Lumbar discectomy performed through minimally invasive techniques has decreased recovery times with similar patient outcomes to open procedures. Performing lumbar microdiscectomy in the outpatient setting is safe, cheaper by as much as 12 934 USD per case and has better or equivalent outcomes to their inpatient counterparts. Unlike ACDF and lumbar microdiscectomy, short segment fusions are rarely performed in ASCs. However, with the advent of minimally invasive techniques paired with improved pain control, same-day discharge after lumbar fusion has limited clinical data but appears to have potential cost-savings up to 65-70% by reducing admissions. Conclusion: Performing ACDF, lumbar discectomy and short segment fusions in the outpatient setting is a safe and effective way of reducing cost in select patient populations.

Prediction of Admission Costs Following Anterior Cervical Discectomy and Fusion Utilizing Machine Learning

“…Healthcare has placed an emphasis on value-based care that assesses the ratio of outcome to cost 30. Even if physicians could consistently deliver the same outcome, the cost associated with each episode of care varies by each patient due to comorbidities, social situation, or additional needs 31. ML models can generate patient-specific reimbursement that incorporates variables that current bundled payment models do not consider.…”

“…Following lumbar fusion, implementation of bundled payment models did not result in cost reduction; however, a higher frequency of performed procedures was observed 32. Additional procedures may be performed more frequently to offset losses incurred from managing complicated patients under bundled payment models 31. Bundled payments may be simpler to implement; however, they place financial responsibility for additional care upon the physician and participating hospital system.…”

“…ML algorithms can identify patients with increased risk of complications,33 which may impact postoperative deposition, follow-up longevity, or site of care. In addition, these models may assist with patient selection for outpatient procedures, which allows for improved financial efficiency as outpatient ACDF has lower direct and total healthcare costs 12,34,35. By utilizing ML, physicians and healthcare systems can ensure adequate resources are available to provide effective and safe care for all patients without causing a significant burden to the hospital system.…”

“…30 Even if physicians could consistently deliver the same outcome, the cost associated with each episode of care varies by each patient due to comorbidities, social situation, or additional needs. 31 ML models can generate patient-specific reimbursement that incorporates variables that current bundled payment models do not consider. Following lumbar fusion, implementation of bundled payment models did not result in cost reduction; however, a higher frequency of performed procedures was observed.…”

Bilateral Outpatient Breast Reconstruction with Stacked DIEP and Vertical PAP Flaps

“…However, with advancements in surgical technique, advent of minimally invasive surgery, appropriate patient selection, surgeon experience and improvement in pain control, anterior cervical discectomy and fusions and numerous other surgeries are now routinely performed on an outpatient basis with equivalent results and decreased expenditure. [4][5][6] Overall, we have identified facility fee as one of the most substantial expenditures and therefore targeted this to increase productivity and decrease cost.…”