49. A systematic review of spine surgery complications in the ambulatory surgical center setting

Abstract

BACKGROUND CONTEXT In recent years, a combination of improved anesthesia, surgical techniques, and technological advances have facilitated a rise in the use of ambulatory surgery centers (ASC). Despite the lower costs associated with ASCs, improved efficiency, and increased patient satisfaction, there is inconsistent reporting of complication rates. PURPOSE This study aims to review current literature in order to determine the outcomes and complication rates in relation to surgery in ambulatory surgical centers. STUDY DESIGN/SETTING Retrospective. PATIENT SAMPLE One hundred and fifty articles on surgery complications in ambulatory surgical centers. OUTCOME MEASURES Postoperative complications (cardiac, GI, MSK, operative, pain, neurologic, pulmonary, urologic, vascular, and wounds). METHODS This systematic review was completed utilizing the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Pertinent studies were identified through Embase and Pubmed databases using the search string (((ambulatory surgery center) AND spine surgery) AND complications). Articles were excluded if they did not report outpatient surgery in an ASC, if they did not define complications in a language other than English, nonhuman studies, or if the articles were classified as reviews, book chapters, single case reports, or small case series (≤10 patients). Comparative studies were only included if they provided the number of both ambulatory and nonambulatory patients. The primary outcome was the frequency of complications with respect to the following categories: cardiac, gastrointestinal, MSK/spine/operative, pain, persistent neurologic, pulmonary, transient neurologic, urologic, vascular, and wound. RESULTS Our query identified 150 articles. After filtering relevance by title, abstract, and full text, 22 articles were included. After accounting for two studies that were conducted on the same study sample, a total of 11,245 patients were analyzed in this study. The most recent study reported results from May 2019. While five studies did not list their surgical technique, reported techniques by each study included open (6), MIS (2), endoscopic (4), microsurgery (1), and combined techniques (4). The following rates of complications were determined: cardiac 2/2168 (0.09%), gastrointestinal 2/1320 (0.15%), MSK/spine/operative 10/8210 (0.12%), pain 10/4634 (0.22%), persistent neurologic 5/3318 (0.15%), pulmonary 1/1839 (0.05%), transient neurologic 11/3821 (0.29%), urologic 2/250 (0.80%), vascular 6/5277 (0.11%), and wound 7/5733 (0.12%). CONCLUSIONS After literature review, this is the first study to comprehensively analyze the current state of literature reporting on the complication profile of all ASC surgery procedures. The most common complications were urologic (0.8%) and the most infrequent were pulmonary (0.05%). Case reports varied significantly with regard to the type and rate of complications reported. Although the patient population undergoing ASC surgery is likely to be screened more rigorously than the inpatient surgery population, this study provides complication profiles to assist surgeons in counseling patients on the most realistic expectations. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.