214. Can posterior cervical decompression and fusion be safely performed in the outpatient settings?

Abstract

<h3>BACKGROUND CONTEXT</h3> Spine surgery has been increasingly performed in the outpatient setting, providing greater control over cost, efficiency, and resources. However, short-term outcomes research evaluating the safety of this trend is limited, particularly with regard to posterior cervical procedures. <h3>PURPOSE</h3> This is the first large-scale database study to compare 30-day readmission, reoperation, and morbidity between posterior cervical decompression and fusion (PCDF) performed in the inpatient and outpatient settings. <h3>STUDY DESIGN/SETTING</h3> Retrospective database study using the 2005-2018 NSQIP datasets. <h3>PATIENT SAMPLE</h3> Adults who underwent PCDF, who were identified in the NSQIP datasets using CPT code 22600 with a decompression code. Patients were excluded if they had anterior, thoracic, lumbar, deformity, revision, nonelective/emergency, infection-related, or tumor surgery. <h3>OUTCOME MEASURES</h3> Thirty-day readmission, reoperation, morbidity, and predictors thereof. <h3>METHODS</h3> Baseline differences were analyzed using Student t test for continuous and chi-squared or Fisher's exact test for categorical variables. Univariate and multivariate regression was used to compare readmission, reoperation, and morbidity between surgical settings, and to evaluate for predictors. <h3>RESULTS</h3> A total of 8,912 patients (353 outpatient) were identified. Outpatients were younger (55.1 vs 61.5 years, p<0.001); less likely to be functionally dependent (1.1% vs 4.5%, p=0.002) and discharged to rehabilitation (7.4% vs 25.2%, p<0.001); more likely to be smokers (32.9% vs 24.7%, p=0.001) and obese (52.1% vs 45.7%, p=0.018); and less likely to have hypertension (47.6% vs 58.9%), ASA-class ≥3 (47.9% vs 63.8%), and low preoperative hematocrit (9.9% vs 18.5%) (p<0.001). Outpatients had shorter OR time (126 vs 179 minutes) and fewer levels fused (1.8 vs 2.2) (p<0.001). Outpatients had significantly lower rates of readmission (4.7% vs 8.8%, p=0.020), reoperation (1.7% vs 3.8%, p=0.038), and morbidity (4.5% vs 11.2%, p<0.001). After adjusting for baseline differences and predictors of outcomes, multivariate analysis revealed that readmission (p=0.236, OR=1.436), reoperation (p=0.524, OR=1.317), and morbidity (p=0.716, OR=1.108) were similar between surgical settings. Age (p=0.008, OR=1.012) and increased creatinine (p<0.001, OR=2.233) predicted readmission. ASA-class ≥3 predicted reoperation (p=0.028, OR=1.406). Rehabilitation discharge (p<0.001, OR=1.412), ASA-class ≥3 (p=0.008, OR=1.296), decreased hematocrit (p<0.001, OR=1.700), and OR time (p<0.001, OR=1.005) predicted morbidity. <h3>CONCLUSIONS</h3> After controlling for potential confounding factors including baseline patient differences and predictors of primary outcomes, rates of 30-day readmission, reoperation, and morbidity were statistically similar between inpatients and outpatients undergoing PCDF. Increased age, ASA-class ≥3, and low preoperative hematocrit predicted worse 30-day outcomes. These findings suggest that PCDF can safely be performed in the outpatient setting. These results are particularly important as we continue to shift spine surgery to outpatient centers. The importance of this has been highlighted by the ongoing need to unburden inpatient sites. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.