Syed I Khalid1, Owoicho Adogwa2, Amelia Ni3, Joseph Cheng4, Carlos Bagley5. 1. Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois, USA; Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, Illinois, USA. 2. Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois, USA. Electronic address: owoicho.adogwa@gmail.com. 3. Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois, USA. 4. Department of Neurosurgery, University of Cincinnati Medical Center, Cincinnati, Ohio, USA. 5. Department of Neurosurgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
Abstract
BACKGROUND: Same-day surgery has been demonstrated to be a safe and cost-effective alternative to traditional inpatient surgery. Several studies have demonstrated no differences in the postoperative complication profile or 30-day hospital readmission rates with outpatient versus inpatient anterior cervical discectomy and fusion (ACDF). However, none of these studies compared the outcomes in elderly patients (aged >65 years) undergoing ACDF. Whether the results from previous studies can be applied to this subgroup pf patients remains unknown. The aim of the present study was to compare the 30-day hospital readmission rates for Medicare patients (aged >65 years) undergoing outpatient versus inpatient ACDF. METHODS: We performed a retrospective analysis of a Medicare database, including data from 17,421 patients. Of the 17,421 patients, 16,386 had undergone inpatient ACDF and 1035, outpatient ACDF. Age, sex, comorbidities, postoperative complications, readmission rates, and overall financial costs were compared between the 2 cohorts. RESULTS: In a Medicare sample (aged >65 years), inpatient ACDF was associated with a greater incidence of postoperative complications compared with outpatient ACDF. Outpatient surgery was associated with significantly lower rates of postoperative complications (urinary tract infection, surgical site infection, deep vein thrombosis, pulmonary embolism, and myocardial infarction) and significantly lower treatment costs (P ≤ 0.001). All-cause 30-day hospital readmission rates were also greater for inpatients (10.1% vs. 4%; P = 0.17). CONCLUSION: The results from the present study suggest that outpatient ACDF appears to be safe and effective with low complication and readmission rates in a Medicare patient sample.
BACKGROUND: Same-day surgery has been demonstrated to be a safe and cost-effective alternative to traditional inpatient surgery. Several studies have demonstrated no differences in the postoperative complication profile or 30-day hospital readmission rates with outpatient versus inpatient anterior cervical discectomy and fusion (ACDF). However, none of these studies compared the outcomes in elderly patients (aged >65 years) undergoing ACDF. Whether the results from previous studies can be applied to this subgroup pf patients remains unknown. The aim of the present study was to compare the 30-day hospital readmission rates for Medicare patients (aged >65 years) undergoing outpatient versus inpatient ACDF. METHODS: We performed a retrospective analysis of a Medicare database, including data from 17,421 patients. Of the 17,421 patients, 16,386 had undergone inpatient ACDF and 1035, outpatientACDF. Age, sex, comorbidities, postoperative complications, readmission rates, and overall financial costs were compared between the 2 cohorts. RESULTS: In a Medicare sample (aged >65 years), inpatient ACDF was associated with a greater incidence of postoperative complications compared with outpatientACDF. Outpatient surgery was associated with significantly lower rates of postoperative complications (urinary tract infection, surgical site infection, deep vein thrombosis, pulmonary embolism, and myocardial infarction) and significantly lower treatment costs (P ≤ 0.001). All-cause 30-day hospital readmission rates were also greater for inpatients (10.1% vs. 4%; P = 0.17). CONCLUSION: The results from the present study suggest that outpatientACDF appears to be safe and effective with low complication and readmission rates in a Medicare patient sample.
Authors: Hannah K Weiss; Jonathan T Yamaguchi; Roxanna M Garcia; Wellington K Hsu; Zachary A Smith; Nader S Dahdaleh Journal: World Neurosurg Date: 2020-01-28 Impact factor: 2.104