5 details on outpatient spine surgery safety in ASCs from 'Neurosurgery' analysis

Research published in Neurosurgery found outpatient spine procedures are just as safe or safer than procedures performed in an inpatient setting.

Researchers examined data from 39 published studies on the PubMed database covering anterior cervical discectomy and fusion, posterior cervical foraminotomy, cervical arthroplasty, lumbar laminectomy and discectomy and lumbar fusion in outpatient and inpatient settings. The studies included in the research were not restricted by the age of patients, or the year the study was published.

Here are the key takeaways:

1. For outpatient anterior cervical discectomy and fusion procedures, a study using the National Surgical Quality Improvement Program tracking 4,759 outpatient ACDFs reported a complication rate of 1.5 percent. For inpatient ACDFs, the complication rate was 3.9 percent, with the researchers citing the findings from 3,135 outpatient procedures in a study published in Neurosurgery in 2017.

2. For posterior cervical foraminotomy procedures, the researchers cited three studies showing outpatients experienced symptom improvement and had a complication rate of 2.2 percent. The researchers studied data from 452 PCF patients in total from three studies.

3. Outpatient cervical arthroplasty procedures were 84 percent less costly than inpatient procedures, the study found. The researchers pulled from two studies reporting outcomes for the procedure. Both inpatient and outpatient cervical arthroplasty had a similar dysphagia rate of 10.9 percent, but no serious complications were reported for either inpatient or outpatient procedures.

4. Complication rates for ambulatory lumbar discectomy or laminectomy are in the range of 0.4 percent to 3.3 percent, with the researchers pulling data from a 2015 study covering 1,073 outpatient procedures. Another study cited by the researchers from 2007 included 243 patients, including 35 over the age of 80, and reported a complication rate of 2.5 percent. In a 2010 study of over 400 patients, the ASC revision rate was 4.3 percent. Most of the studies examined included patients under the age of 65.

5. Patients who underwent outpatient lumbar fusion experienced lower perioperative readmission rates (3.1 percent) compared to inpatients (4.7 percent) in a 2016 study including 64 inpatients and 32 outpatients. In a 2014 study cited by researchers, both inpatients and outpatients reported a 9 percent complication rate.

6. "While further studies are needed to understand how best to select optimal patients for ASCs and maximize perioperative analgesia, the fact remains that the evidence for the safety and utility of multiple outpatient spine procedures is robust and growing," researchers concluded. "In light of this, providers, payers, hospitals and patients all stand to benefit if greater investments are made in ASCs for spine surgery."

Click here to read the full study.

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