Not All Outpatient Surgery May be the Same: Differences in Outcomes between Ambulatory Surgical Center (ASC) and Hospital Outpatient for Patients Undergoing Routine Anterior Cervical Discectomy and Fusion. (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_741
• Languages: English
• ISSNs: 0148-396X

Abstract

Abstract: INTRODUCTION: To date, the safety and efficiency for outpatient spine surgery has largely been assessed comparing the outcomes between hospital outpatient and hospital inpatient. Very few studies have made a distinction between hospital outpatient and free-standing ambulatory surgical centers (ASCs). METHODS: We primarily used the Florida State Ambulatory Surgery Database (SASD) of the Healthcare Cost and Utilization Project (HCUP), to identify patients with degenerative cervical disease undergoing an ACDF. We subsequently identified readmissions to the same or another outpatient facility, to an inpatient facility using the State Inpatient Database (SID), and to emergency departments using the State Emergency Department Database (SEDD). 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. Patients in the ASC group were less likely to have an overnight observation stay (0% vs 15.8%, n = 401, P < .001), were less likely to have a non-routine discharge (0.4% vs 2.5%, P < .001). Patients in the ASC group were more likely to have a 7-day, 30-day and 90-day outpatient readmission (1.4%, 2% and 3.3% vs 0.6%, 0.9% and 1.8%, P = .004, P = .005 and P = .012, respectively). Patients in the ASC group were also more likely to undergo a 7-day repeat procedure (inpatient or outpatient) (1.3% vs 0.6%, P = .030) and 90-day repeat outpatient procedure (3.8% vs 2.4%, P = .043). On multivariable analysis, adjusting for age, sex, number of comorbidities, insurance type and number of levels operated, ASC group was independently associated with significantly higher odds of a 90-day readmission to any facility (OR:1.53, P = .03); 7-day (OR:4.47, P = .01), 30-day (OR:3.92, P = .003), and 90-day outpatient readmissions (OR:3.00, P = .002), 7-day (OR:4.44, P = .01), 30-day (OR:2.50, P = .01), and 90-day (OR: 2.58, P = .003) repeat procedure; 7-day (OR:4.07, P = .01), 30-day (OR:3.71, P = .005) and 90-day (OR 3.63, P = .001) and 90-day outpatient reoperation. CONCLUSION: These results indicate that outpatient ACDF at an ASC may be associated with higher odds of readmission and reoperation.