Outpatient spinal fusion: 2 new studies compare outcomes

Two recent studies published in The Spine Journal examine spine surgery in the outpatient setting.

The first looks at posterior lumbar fusions with and without interbody. Study authors examined the American College of Surgeons National Surgical Quality Improvement Program from 2005 to 2015 to include 360 outpatient and 36,610 inpatient PLF cases. After propensity matching, study authors found no significant difference in the adverse events except blood transfusion rate. Nearly 3 percent of the outpatient group required blood transfusions, compared to 10.8 percent of the inpatient group.

The rate of readmissions was similar between both groups.

"Based on the lack of differences in rates of most perioperative complications and 30-day readmissions between the outpatient and inpatient cohorts, it seems that outpatient PLF may be appropriately considered for selected patients," concluded the study authors. "However, extremely careful patient selection should be exercised."

The second study addresses anterior cervical discectomy and fusion. The authors of this study examined the PearlDriver Humana insurance database and analyzed data for one-and two-level fusions. The study included 1,215 patients who underwent outpatient procedures and 10,964 who underwent inpatient procedures from 2011 to 2016. 

Study authors found patients were more likely to undergo revision surgery after outpatient procedures than those who received posterior fusions at six months and one year after surgery. Outpatient ACDF was also associated with higher rates of postoperative acute renal failure than inpatient procedures.

"Nationwide data demonstrates greater risk of perioperative surgical complications including revision anterior and posterior fusion, as well as higher risk for postoperative acute renal failure," concluded the study authors. "Candidates for outpatient ACDF should be counseled and carefully selected to reduce these risks."

More articles on outpatient spine surgery:
The best advice for young spine surgeons at the beginning of their careers
How the CMS final payment rule will affect spine surgeons—5 key notes
4 key points on factors associated with lumbar spinal fusion 90-day readmissions

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