Elizabeth Hofheinz, M.P.H., M.Ed.
With spine procedures moving to outpatient centers, it is more necessary than ever that patients be optimized prior to surgery. A new retrospective cohort study from The Rothman Orthopaedic Institute in Philadelphia has homed in on what things are likely to set the stage for a successful surgery. The study, “Preoperative factors associated with outpatient lumbar decompression surgery,” was published in the September 1, 2020 edition of The Spine Journal.
The investigators looked at patients who had anywhere from a 1- to 4-level lumbar decompression, defining outpatient as a LOS of 0 or 1 day. Inpatient was defined as a stay of 2 or more days.
The authors wrote, “Comparison of baseline patient demographics demonstrated a significant difference between outpatient and inpatient surgery cohorts for age greater than 75, gender, BMI [body mass index] greater than 35, ASA [American Society of Anesthesiologists score), insurance status, levels decompressed, history of diabetes mellitus (DM), preoperative VAS [Visual Analog Score] leg score, and readmission events. Fewer patients were readmitted after an outpatient procedure (3.5%); however, more patients in this group were found to return to the ER after discharge (6.3%). Multivariate logistic regression models demonstrated that age >75, female gender, ASA class 2 and class 3, private/other insurance status, history of DM, and preoperative VAS leg were found to be significant independent preoperative factors associated with patients undergoing outpatient lumbar decompression surgery…”
Co-author Alan S. Hilibrand, M.D. is The Joseph and Marie Field Professor of Spinal Surgery, Vice Chairman of Academic Affairs and Faculty Development, Co-Chief of Spinal Surgery, Director of Orthopaedic Medical Education and Professor of Orthopaedic and Neurological Surgery at Jefferson Medical College / The Rothman Orthopaedic Institute.
“This paper confirms what many would assume, that patients who are selected for outpatient surgery are different than those staying inpatient…younger, healthier, and less severe disease,” said Dr. Hilibrand to OSN. “The interesting finding is that although the inpatient cohort had more readmissions the outpatients had more followup/ER visits.”
The authors mention that more studies are needed to validate these findings and to develop computer-assisted algorithms that can help predict patient discharge disposition and minimize patient risks and resource utilization.
Dr. Hilibrand told OSN “I think that in an ideal world we would be very precise in global reimbursements for procedures based upon a patient’s health and burden of disease. This highlights how that might work.”