131. Primary single-level lumbar discectomy/decompression at a free-standing ambulatory surgery center (ASC) vs a hospital-owned outpatient facility (HOPD): an analysis of 90-day outcomes and costs

Abstract

BACKGROUND CONTEXT Over the past decade, free-standing ambulatory surgery centers (ASCs) have increasingly grown in numbers in many regions. ASCs are independent of hospitals and are often owned by physicians or unaffiliated management companies. Because ASCs are free-standing, they do not have direct access to hospital inpatient facilities or emergency rooms. Though free-standing ASCs are increasingly utilized for routine elective spine surgeries, no study has evaluated the surgical safety and cost savings associated with performing surgery at a free-standing ASC vs a hospital-owned outpatient facility (HOPD). PURPOSE To evaluate differences in 90-day outcomes and costs associated with primary single-level lumbar discectomy/decompressions performed at a free-standing ASC vs. a HOPD. STUDY DESIGN/SETTING Retrospective review of 2007-2017Q1 Humana Administrative Claims (HAC) database. PATIENT SAMPLE The Humana 2007-2017Q1 Administrative Claims (HAC) dataset of Medicare Advantage and Commercial beneficiaries, was queried using Current Procedural Terminology codes 63030, 63056 and 0275T to identify patients undergoing primary single-level lumbar discectomy/decompressions. Patients undergoing two-level surgery, laminectomies, fusions, revision discectomies and/or deformity surgeries were excluded. Service location codes for hospital outpatient (22) and free-standing ASC (24) were used to define two groups. OUTCOME MEASURES Ninety-day complications, readmissions, emergency department (ED) visits and costs. METHODS Patients undergoing surgery at an ASC were case-control matched to patients undergoing surgery at an HOPD on the basis of age, gender, race, region and Elixhauser Co-morbidity Index (ECI) to reduce any selection bias. Following matching, Chi-square tests were used to assess significant differences in 90-day complications, readmissions, ED visits and costs. RESULTS A total of 1,077 and 10,475 primary single-level discectomy/decompressions were performed in ASCs and HO facilities respectively. Following matching, the two cohorts comprised of 990 patients each. Although 90-day complications (ASC=9.1% vs. HO=10.3%; p=0.362) and readmissions (ASC=4.5% vs HO=5.3%; p=0.466) were lower in ASCs, these were not statistically significant. On average, performing surgery in an ASC vs. HO resulted in significant cost savings of over $2000/case in Medicare Advantage ($5,814 vs. $7,829) and over $3,500/case ($10,116 vs. $13,623) in Commercial beneficiaries. CONCLUSIONS Performing single-level discectomy/decompression surgeries in an ASC, as compared to hospital outpatient facilities, was associated with around $2,000-$3,500 cost savings per case with no significant impact on complication and readmission rates. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.