Lightning Podiums: Cervical Degenerative - Room 802A

Presented by: D. Park

Author(s):

D. Park(1), A. Arshi(2), H. Park(2), C. Wang(3), Z. Buser(3), J. Wang(3), A. Shamie(2)

(1) UCLA, Orthopaedic Surgery, Santa Monica, CA, United States
(2) UCLA, Los Angeles, CA, United States
(3) University of Southern California, Los Angeles, CA, United States

Abstract

Introduction: With the changing landscape of healthcare, outpatient spine surgery is more commonly performed to reduce cost and improve efficiency. Anterior cervical discectomy and fusion (ACDF) is one of the most common spine surgeries performed and demand is expected to increase with an aging population. The purpose of this study was to determine the nationwide trends and complication rates associated with outpatient ACDF as compared to inpatient ACDF.

Methods: A retrospective review was performed of the Humana subset of the PearlDiver insurance records database to identify patients undergoing single level ACDF (CPT-22551 AND ICD-9-816.2) as either outpatients or inpatients from 2011-2016. The incidence of perioperative medical and surgical complications was determined by querying for relevant International Classification of Diseases and Current Procedural Terminology codes. Multivariate logistic regression adjusting for age, gender, and Charlson Comorbidity Index was used to calculate odds ratios (OR) of complications among outpatients relative to inpatients undergoing ACDF.

Results: Cohorts of 1,215 patients who underwent outpatient ACDF and 10,964 patients who underwent inpatient ACDF were identified. The median age was in the age 65-69 age group for both cohorts. The annual relative incidence of outpatient ACDF increased from 0.11 in 2011 to 0.22 in 2016 (R2=0.82, p=0.04). Adjusting for age, gender, and comorbidities, patients undergoing outpatient ACDF were more likely to undergo revision surgery for posterior fusion at both 6 months (OR 1.58, CI 1.27-1.96, p< 0.001) and one year postoperatively (OR 1.79, CI 1.51-2.13, p< 0.001). Outpatient ACDF patients were also more likely to undergo revision anterior fusion surgery with extension at one year postoperatively (OR 1.46, CI 1.26-1.70, p< 0.001). Rates of hardware removal, surgical wound exploration, dural tears, and neurological injury were statistically comparable. Among medical complications, postoperative acute renal failure was more frequently associated with outpatient ACDF than inpatient (OR 1.25, CI 1.06-1.49, p=0.010), while the rates of major thromboembolic, respiratory, and cardiovascular events were statistically comparable. Discussion and

Conclusions: Outpatient spine surgery is growing increasingly popular due to changes in healthcare delivery and greater attention to cost reduction and improved efficiency. Data collected from a national private insurance database demonstrates greater risk of perioperative surgical complications associated with outpatient ACDF, including revision anterior and posterior fusion, as well as higher risk for postoperative acute renal failure. Candidates for outpatient ACDF should be counseled and carefully selected to reduce these risks.