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. 2021 Apr;11(1_suppl):56S-65S.
doi: 10.1177/2192568220968772.

Recoup From Home? Comparison of Relative Cost Savings for ACDF, Lumbar Discectomy, and Short Segment Fusion Performed in the Inpatient Versus Outpatient Setting

Christopher M Mikhail  1 , Murray Echt  2 , Stephen R Selverian  1 , Samuel K Cho  1
Affiliations

Recoup From Home? Comparison of Relative Cost Savings for ACDF, Lumbar Discectomy, and Short Segment Fusion Performed in the Inpatient Versus Outpatient Setting

Christopher M Mikhail et al. Global Spine J. 2021 Apr.

Abstract

Study design: Broad narrative review.

Objective: To review and summarize the current literature on the cost efficacy of performing ACDF, lumbar discectomy and short segment fusions of the lumbar spine performed in the outpatient setting.

Methods: A thorough review of peer- reviewed literature was performed on the relative cost-savings, as well as guidelines, outcomes, and indications for successfully implementing outpatient protocols for routine spine procedures.

Results: Primary elective 1-2 level ACDF can be safely performed in most patient populations with a higher patient satisfaction rate and no significant difference in 90-day reoperations and readmission rates, and a savings of 4000 to 41 305 USD per case. Lumbar discectomy performed through minimally invasive techniques has decreased recovery times with similar patient outcomes to open procedures. Performing lumbar microdiscectomy in the outpatient setting is safe, cheaper by as much as 12 934 USD per case and has better or equivalent outcomes to their inpatient counterparts. Unlike ACDF and lumbar microdiscectomy, short segment fusions are rarely performed in ASCs. However, with the advent of minimally invasive techniques paired with improved pain control, same-day discharge after lumbar fusion has limited clinical data but appears to have potential cost-savings up to 65-70% by reducing admissions.

Conclusion: Performing ACDF, lumbar discectomy and short segment fusions in the outpatient setting is a safe and effective way of reducing cost in select patient populations.

Keywords: ACDF; cost analysis; microdiscectomy; outpatient surgery; short segment fusion.

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Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article. Dr. Cho has financial relationships with Corentec (paid consultant), Medtronic (paid consultant), Globus (paid consultant), and Zimmer (paid consultant, research support). None of the remaining authors have any financial interests or affiliations with institutions, organizations, or companies relevant to the manuscript. None of the authors received payment or support in kind for any aspect of the submitted work.

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