A new study published in Spine examines outpatient spine surgery in ambulatory surgery centers for predictive factors and clinical results. William D. Smith, MD, Richard N. Wohns, MD, JD, MBA, Ginger Christian, Evelyn J. Rodgers and W. Blake Rodgers, MD, authored the article.
The researchers underwent two analyses, one examining patient characteristics of postoperative discharge in less than 24 hours and the others examining patients treated at an ambulatory surgical center for lumbar fusion. There were 1,033 patients who underwent minimally invasive lateral interbody fusion using the XLIF procedure.
In the ASC group, 54 consecutive patients were treated with XLIF and 18 consecutive patients treated with MIS posterior fusion.
The researchers found:
1. There were 873 patients in the hospital group who were discharged in less than 24 hours and 160 patients were discharged after more than 24 hours.
2. The strongest baseline predictors of early discharge were:
Less advanced diagnosis
Younger patients
Elevated baseline hemoglobin levels
Lower body mass index
The most predictive treatment variables for early discharge were fewer levels treated and the elevated hemoglobin.
3. The average age for the patients undergoing outpatient surgeries was 50.6 years old and 53.2 years old, and 95 percent of the cases were performed at one or two levels for degenerative disease.
4. The researchers didn't see any intraoperative complications and few postoperative complications for the XLIF or MIS posterior procedures. There weren't any emergent transfers to inpatient facilities from the ambulatory setting.
5. The outpatient spine surgery procedures could have a positive impact on the cost of spine procedures. The study authors wrote, "Additionally, even those who question the utilization and associated costs of lumbar spine procedures in general admit that in instances where it has been shown to be reproducible, spine surgery in an outpatient or ambulatory surgery center can have a substantial impact on reigning in medical costs and may result in a better experience for the patient."
Medicare is also moving to reimburse cervical and lumbar fusions as well as posterior decompressions in ASCs.
The study authors concluded, "Select patients, by health and indication, can safely be treated as outpatients with XLIF or other modern MIS approaches."