Thursday, September 27, 2018 8:30 AM–9:30 AM Best Papers: 104. Ambulatory anterior cervical discectomy and fusion is associated with a higher risk of perioperative complications

Abstract

BACKGROUND CONTEXT With the changing landscape of health care, outpatient spine surgery is more commonly performed to reduce cost and improve efficiency. Anterior cervical discectomy and fusion (ACDF) is one of the mo st common spine surgeries performed and demand is expected to increase with an aging population. PURPOSE The purpose of this study was to determine the nationwide trends and complication rates associated with outpatient ACDF as compared to inpatient ACDF. STUDY DESIGN/SETTING This study is a retrospective review utilizing the Humana subset of the PearlDiver insurance records database. PATIENT SAMPLE The patient sample consisted of patients undergoing single level ACDF (CPT-22551 AND ICD-9-816.2) as either outpatients or inpatients from 2011 to 2016. OUTCOME MEASURES Perioperative medical and surgical complications were identified by querying for relevant International Classification of Diseases and Current Procedural Terminology codes. METHODS The incidence of perioperative medical and surgical complications was determined after the database query was performed. 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=.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 CONCLUSIONS Outpatient spine surgery is growing increasingly popular due to changes in health care 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. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.