Kimon Bekelis1, Symeon Missios2, George Kakoulides3, Redi Rahmani4, Nathan Simmons5. 1. Department of Neurosurgery, Dartmouth-Hitchcock Medical Center, One Medical Center Dr, Lebanon, NH 03756, USA. Electronic address: kbekelis@gmail.com. 2. Coastal NH Neurosurgeons, Portsmouth Hospital, 330 Borthwick Ave, Portsmouth, NH 03801, USA. 3. Department of Neurosurgery, Dartmouth-Hitchcock Medical Center, One Medical Center Dr, Lebanon, NH 03756, USA. 4. Geisel School of Medicine at Dartmouth, 1 Rope Ferry Road, Hanover, NH 03755, USA. 5. Department of Neurosurgery, Dartmouth-Hitchcock Medical Center, One Medical Center Dr, Lebanon, NH 03756, USA; Geisel School of Medicine at Dartmouth, 1 Rope Ferry Road, Hanover, NH 03755, USA.
Abstract
BACKGROUND CONTEXT: There is a persistent trend for more outpatient lumbar discectomies in the United States. PURPOSE: To investigate the characteristics of the patients selected for ambulatory procedures. STUDY DESIGN: Retrospective cohort study. PATIENT SAMPLE: Forty-seven thousand one hundred twenty-five patients who underwent outpatient and 102,592 patients undergoing inpatient lumbar discectomies and were were registered in the State Ambulatory Surgery Database (SASD) and State Inpatient Database (SID), respectively, for New York, California, Florida, and North Carolina from 2005 to 2008. OUTCOME MEASURES: Rate of outpatient procedures, 30-day readmissions, and hospital charges. METHODS: We performed a retrospective cohort study involving patients who underwent outpatient and inpatient lumbar discectomies and were registered in SASD and SID, respectively, for New York, California, Florida, and North Carolina from 2005 to 2008. Logistic regression models were used to demonstrate the association of socioeconomic factors with the odds of undergoing an outpatient procedure. RESULTS: Male gender (odds ratio [OR], 1.05; 95% confidence interval [CI], 1.03-1.08), private insurance (OR, 1.93; 95% CI, 1.86-2.01), lower Charlson Comorbidity Index (OR, 4.04; 95% CI, 3.17-5.16), and higher volume hospitals (OR, 1.06; 95% CI, 1.04-1.08) were significantly associated with outpatient procedures. Higher income (OR, 0.83; 95% CI, 0.81-0.85), older age (OR, 0.996; 95% CI, 0.995-0.997), coverage by Medicaid (OR, 0.89; 95% CI, 0.83-0.96), African Americans (OR, 0.65; 95% CI, 0.60-0.70), and other minority races were associated with decreased odds of outpatient procedures. The rate of 30-day postoperative readmissions was higher among inpatients. Institutional charges were significantly lower for outpatient lumbar discectomies. The median charge for inpatient surgery was $24,273 as compared with $11,339 for the outpatient setting (p<.0001). CONCLUSIONS: Access to ambulatory lumbar discectomies appears to be more common for younger, white, male patients, with private insurance and less comorbidities, in the setting of higher volume hospitals. Further investigation is needed in the direction of mapping these disparities for appropriate resource utilization.
BACKGROUND CONTEXT: There is a persistent trend for more outpatient lumbar discectomies in the United States. PURPOSE: To investigate the characteristics of the patients selected for ambulatory procedures. STUDY DESIGN: Retrospective cohort study. PATIENT SAMPLE: Forty-seven thousand one hundred twenty-five patients who underwent outpatient and 102,592 patients undergoing inpatient lumbar discectomies and were were registered in the State Ambulatory Surgery Database (SASD) and State Inpatient Database (SID), respectively, for New York, California, Florida, and North Carolina from 2005 to 2008. OUTCOME MEASURES: Rate of outpatient procedures, 30-day readmissions, and hospital charges. METHODS: We performed a retrospective cohort study involving patients who underwent outpatient and inpatient lumbar discectomies and were registered in SASD and SID, respectively, for New York, California, Florida, and North Carolina from 2005 to 2008. Logistic regression models were used to demonstrate the association of socioeconomic factors with the odds of undergoing an outpatient procedure. RESULTS: Male gender (odds ratio [OR], 1.05; 95% confidence interval [CI], 1.03-1.08), private insurance (OR, 1.93; 95% CI, 1.86-2.01), lower Charlson Comorbidity Index (OR, 4.04; 95% CI, 3.17-5.16), and higher volume hospitals (OR, 1.06; 95% CI, 1.04-1.08) were significantly associated with outpatient procedures. Higher income (OR, 0.83; 95% CI, 0.81-0.85), older age (OR, 0.996; 95% CI, 0.995-0.997), coverage by Medicaid (OR, 0.89; 95% CI, 0.83-0.96), African Americans (OR, 0.65; 95% CI, 0.60-0.70), and other minority races were associated with decreased odds of outpatient procedures. The rate of 30-day postoperative readmissions was higher among inpatients. Institutional charges were significantly lower for outpatient lumbar discectomies. The median charge for inpatient surgery was $24,273 as compared with $11,339 for the outpatient setting (p<.0001). CONCLUSIONS: Access to ambulatory lumbar discectomies appears to be more common for younger, white, male patients, with private insurance and less comorbidities, in the setting of higher volume hospitals. Further investigation is needed in the direction of mapping these disparities for appropriate resource utilization.
Authors: Jason M Cuellar; Edward Nomoto; Ehsan Saadat; Anthony Ma; Patrick Hill; Michael Kropf; Todd H Lanman; Brian Perri; Khawar Siddique; Willis Wagner; Rajeev Rao; Albert Wong; Michael Eng; Stephen Stephan; Neel Anand; Hyun Bae; Alexandre Rasouli Journal: Int J Spine Surg Date: 2021-09-22
Authors: Margaret A Olsen; Fang Tian; Anna E Wallace; Katelin B Nickel; David K Warren; Victoria J Fraser; Nandini Selvam; Barton H Hamilton Journal: Ann Surg Date: 2017-02 Impact factor: 12.969