Elective neurosurgery has quietly crossed a threshold: advances in minimally invasive techniques, anesthesia, and perioperative care have made a set of historically “inpatient” spine and neurovascular procedures both safe and efficient in ASCs. Organizations that proactively redesign site-of-care strategy around this reality can unlock significant savings and capacity while maintaining high outcomes.
“The ASC question is no longer ‘if’ for many neurosurgical procedures: it is ‘how fast’ and ‘which cases first?’”
1. Lumbar Decompression (Laminectomy, Laminotomy, Microdiscectomy)
Ambulatory lumbar decompression is one of the most mature plays for neurosurgical ASCs. A recent U.S. study of Medicare beneficiaries undergoing lumbar laminectomy showed no differences in 90-day ED visits, readmissions, one-year reoperations, or one-year utilization between ASCs and HOPDs after risk adjustment.
At the same time, ASC facility/technical fees for decompression are substantially lower than HOPD rates despite identical CPT codes and surgeon professional fees. For commercially insured patients with high deductibles, that gap translates into materially lower out-of-pocket costs for the same procedure.
2. One-Level ACDF
Outpatient one-level ACDF has strong evidence behind it. Systematic reviews demonstrate that ACDF performed in ambulatory settings has similar or lower rates of reoperation and readmission compared with inpatient care, without higher complication rates.
Large series of 1,000 consecutive outpatient ACDF cases show no increase in major complications compared with inpatient comparators. Medicare-eligible patients treated in ASC settings have low 30- and 90-day adverse events, no intra-operative deaths, and minimal unplanned transfers.
3. Two-Level ACDF in Selected Patients
As protocols mature, some centers have extended ASC ACDF to selected two-level cases. Contemporary ASC series—including older adults—report 90-day readmission and reoperation rates well under 5 percent when stringent selection criteria and enhanced recovery protocols are in place.
These cases require robust pre-operative screening, careful anesthesia planning, and clear post-discharge pathways, but they demonstrate that complexity can increase without sacrificing safety or efficiency in the ASC.
4. Short-Segment Lumbar Fusion
While still controversial in some markets, short-segment lumbar fusion in optimized patients is emerging as an ASC opportunity. Enhanced recovery after surgery (ERAS) pathways, better hemostasis, and improved pain control have shortened length of stay, making overnight hospital care unnecessary for selected patients.
In ASC environments where neurosurgeons control implant choice and supply chain, the combination of lower facility fees and more disciplined device utilization can materially reduce total episode cost without compromising outcome.
5. Kyphoplasty and Vertebroplasty
Vertebral augmentation procedures—kyphoplasty and vertebroplasty—are well suited to the ASC model. They are relatively short, image-guided interventions with predictable recovery profiles and low complication rates in appropriately selected patients.
Shifting these procedures from hospital outpatient radiology or OR suites to ASCs leverages lower technical fees and higher throughput, while freeing hospital capacity for more complex or emergent cases.
6. Diagnostic Cerebral Angiography
Emerging data show that diagnostic cerebral angiography can be performed safely in outpatient endovascular centers, including neurosurgical ASCs. Early series report near-zero periprocedural complications and very high patient satisfaction scores on short-term follow-up.
This shift not only reduces facility charges but also decompresses hospital biplane angiography suites, which can then prioritize high-acuity stroke and aneurysm interventions.
7. Selected Endovascular and Neurovascular Interventions
Beyond diagnostic work, complementary reviews of outpatient endovascular practice in radiology, cardiology, and vascular surgery suggest that many vascular and neurovascular interventions can transition safely to office-based or ASC environments. When combined with careful case selection and standardized protocols, neurosurgical endovascular programs can mirror these results.
“The same endovascular tools that transformed inpatient stroke care can now be deployed in outpatient centers for carefully selected neurovascular cases.”
What the Data Say: Cost and Outcomes by Site
Representative cost and outcome profiles
| Procedure | Site of care | Relative facility/technical cost | Key outcome signal |
|---|---|---|---|
| Lumbar laminectomy | ASC | Lower facility fees | No difference in 90-day ED visits/readmissions vs HOPD. |
| ACDF (1 level) | ASC | Lower facility fees | Similar or lower complications and readmissions vs inpatient. |
| Diagnostic cerebral angiography | ASC | Lower technical cost | Near-zero procedural complications, high satisfaction. |
For payers and employers, these shifts represent a straightforward way to reduce total cost of care while maintaining quality metrics; for neurosurgeons and health systems, they offer a blueprint for building high-acuity ASC portfolios that are clinically credible and economically compelling.
