Outpatient elective posterior lumbar fusions appear to be safely considered for appropriately selected patients

Abstract

Background context: There has been growing interest in performing posterior lumbar fusions (PLFs) in the outpatient setting to optimize patient satisfaction and reduce cost. Although still done in only a small percentage of cases, this has been more possible because of advances in surgical techniques and anesthesia. However, data on the perioperative course of outpatient compared with inpatient PLF in a large sample size are scarce.

Purpose: This study aimed to compare perioperative complications between outpatient and inpatient PLF in the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database.

Study design/setting: A retrospective cohort comparison study was carried out.

Patient sample: Patients undergoing PLF with or without interbody fusion from the 2005 to 2015 NSQIP database comprised the sample.

Outcome measures: Outcome measures were postoperative complications within 30 days and readmission within 30 days.

Methods: Patients who underwent PLF with or without interbody fusion were identified in the 2005-2015 NSQIP database. Outpatient procedures were defined as cases that had hospital length of stay (LOS)=0 days, whereas inpatient procedures were defined as LOS=1-30 days. Patient characteristics, comorbidities, and procedural variables (inclusion of interbody fusion, instrumentation, and number of levels fused) were compared between the two cohorts. Propensity score-matched comparisons were then performed for postoperative complications and 30-day readmissions between the two groups.

Results: The current study included 360 outpatient and 36,610 inpatient PLF cases. After propensity matching to control potential confounding factors, statistical analysis revealed no significant difference in postoperative adverse events other than significantly lower blood transfusions in the outpatient group (2.78% vs. 10.83%, p<.001). Notably, the rate of readmissions was not different between the groups.

Conclusions: Based on the lack of differences in rates of most perioperative complications and 30-day readmissions between the outpatient and inpatient cohorts, it seems that outpatient PLF may be appropriately considered for select patients. However, extremely careful patient selection should be exercised.

Keywords: Complications; NSQIP; Outpatient; Posterior lumbar fusion; Readmissions; Same-day discharge.