Resident Physician University of Alabama at Birmingham Birmingham, Alabama, United States
Introduction: Lumbar spinal fusion has increasingly been performed in the outpatient setting, joining other commonly performed outpatient surgical procedures and offering improved value-based healthcare. The aim of this study was to assess the noninferiority of clinical and patient-reported outcomes (PROs) between outpatient and inpatient lumbar fusion surgery.
Methods: The Quality Outcomes Database (QOD) was queried for patients undergoing elective two- or three-level lumbar arthrodesis for degenerative spine disease with three months follow-up. Patients were assigned to the outpatient group if they had a length of hospital stay (LOS) of less than 24 hours. Patients with a length of hospital stay of 96 or more hours were excluded from the comparative analysis to increase baseline comparability between the two groups. To create two highly homogeneous groups, optimal matching was performed at a 3:1 ratio between the two groups on 32 baseline variables. Outcomes of interest were readmissions and reoperations at 30 days and 3 months after surgery, overall satisfaction, and PROs at 3 months after surgery. The noninferiority of outpatient compared with inpatient surgery was defined as risk difference of < 5.0% at a one-sided 97.5% confidence interval.
Results: A total of 12,296 eligible one- and two-level lumbar fusion surgeries were identified. The matched study cohorts consisted of 298 and 894 patients in outpatient and inpatient groups, respectively. Thirty-day and 3-month readmission and reoperation rates were not significantly different between inpatient and outpatient groups. Overall satisfaction at 3 months was 92.3% for the outpatient group and 92.1% for the inpatient group. Noninferiority of outpatient surgery was documented for non-routine discharge, readmissions, reoperations, and patient-reported satisfaction from surgery.
Conclusion : Outpatient lumbar arthrodesis surgery is non-inferior to inpatient lumbar arthrodesis regarding non-routine discharge, readmissions, reoperations and PROs. Performance of carefully selected lumbar arthrodesis procedures in the outpatient setting has the potential to minimize healthcare costs and maximize value-based healthcare.
