Differences in Rates and Reasons Readmission and Reoperation Between Outpatient Ambulatory Surgery Center (ASC) and Hospital Outpatient Anterior Cervical Discectomy and Fusion: A State-Wide Analysis. (16th November 2020)

• Record Type: Journal Article
• Authors: Bydon, Mohamad; Alvi, Mohammed A; Kurian, Shyam; Jeffery, Molly; Naessens, James; Spinner, Robert J
• Is Part Of: Neurosurgery. Volume 67(2010)Supplement 1
• Publication Date: 2020-11-16
• Subjects: Nervous system -- Surgery -- Periodicals; 617.48005
• DOI: 10.1093/neuros/nyaa447_718
• Languages: English
• ISSNs: 0148-396X

Abstract

Abstract: INTRODUCTION: Outpatient spine surgery has been increasingly adapted in the past decade, given the several touted benefits over inpatient procedure. However, distinction between Ambulatory Surgery Center (ASC) and Hospital Outpatient has rarely been made when describing outcomes of outpatient spine surgery. METHODS: The Florida State Ambulatory Surgery Database (SASD) for the years 2012–2014 was queried for patients undergoing ACDF for degenerative disease. The cohort was grouped by the facility type into Ambulatory Surgery Center (ASC) and hospital outpatient. Reasons for readmission and reoperation procedure were analyzed as 1) overall, 2) 7-day, 3) 30-day and 4) 90-day. RESULTS: A total of 3, 924 patients were identified, of which 35.2% (1, 382) underwent ACDF at an ASC while 64.8% (n = 2, 542) underwent the procedure in a hospital outpatient facility. A total of 118 patients (8.5%) in the ASC group had 161 readmissions in the duration of the analysis, compared to 183 patients (7.2%) with 267 readmissions in the Hospital Outpatient group. The most common reason for readmission in both groups was postoperative pain (ASC:43.5%, n-70; Hospital-Outpatient:6.7%, n = 98), followed by recurrence of preoperative degenerative disease symptoms (ASC: 33.5%, n = 54; Hospital-Outpatient:33%, n = 88) and surgical site infections (ASC:11.2%, n = 18; Hospital-Outpatient: 11.6%, n = 31). A total of 59 patients (4.3%) in the ASC group had a total of 63 reoperations, compared to 78 patients (3.1%) with 87 reoperations in the Hospital-Outpatient group. The most common reoperation in the ASC group was a repeat cervical surgery (56%, n = 42) while in the Hospital-Outpatient group, it was a cervical spine pain injection (37.7%, n = 46). On multivariable analysis, patients in the ASC group were more likely to be readmitted due to recurrence of preoperative symptoms (OR:1.8, 95%CI 1.0-3.1, P = .04) and more likely to have a repeat cervical surgery (OR:2.8, 95%CI 1.4-5.5, P = .003). CONCLUSION: These results indicate that outpatient ACDF at an ASC may be associated with a higher risk of readmission to recurrence of preoperative symptoms and higher risk of a repeat cervical surgery.