Back to Search
Start Over
Trends and Costs of Anterior Cervical Discectomy and Fusion: a Comparison of Inpatient And Outpatient Procedures.
- Source :
-
The Iowa orthopaedic journal [Iowa Orthop J] 2018; Vol. 38, pp. 167-176. - Publication Year :
- 2018
-
Abstract
- Study Design: Epidemiologic Study.<br />Objectives: To identify the trends in utilization of outpatient discharge for single level anterior cervical discectomy and fusion (ACDF), between 2007 and 2014, and to compare the costs and incidence of complications against a cohort of inpatients.<br />Methods: We retrospectively reviewed 18,386 patients from the PearlDiver database from between 2007 and 2014. Discharge status was determined from billing codes. The total cost of all procedures and diagnostic tests, was determined for the global period from the time of diagnosis up until 90-days post-operatively, and the incidence of complications was recorded for 30-days.<br />Results: The proportion of outpatient discharges was stable around 20% from 2007 to 2014 (range17-23%). The mean 90-day cost was lower for outpatients ($39,528 v. $47,330) but reimbursement fell nearly 1/3 from 2007-2014 for both groups, and the difference between the two narrowed over time ($13,745 difference in 2008, to $3,834 in 2014). Outpatients had a lower incidence of overall 30-day complications (9.5% v. 18.6%, p<0.0001), but were also significantly less comorbid (mean Charlson comorbidity index 2.32 v. 3.85, p<0.001). Older patient age, obesity, cardiac, renal, and pulmonary comorbidity were each more common in the inpatients (p<0.05 for each).<br />Conclusions: Outpatient discharge after ACDF is a viable treatment option with a reasonable safety profile and decreased costs relative to inpatient admission. Appropriate patient selection is key, and the standard of care nationally for the comorbid patient remains inpatient admission. The economic trends and epidemiologic data presented here should be useful for health policy decisions.<br />Competing Interests: Conflict of Interest Statement:
- Subjects :
- Adult
Aged
Ambulatory Surgical Procedures methods
Ambulatory Surgical Procedures trends
Diskectomy methods
Diskectomy trends
Female
Humans
Inpatients
Male
Middle Aged
Outpatients
Retrospective Studies
Spinal Fusion methods
Spinal Fusion trends
Ambulatory Surgical Procedures economics
Cervical Vertebrae surgery
Diskectomy economics
Health Care Costs
Spinal Fusion economics
Subjects
Details
- Language :
- English
- ISSN :
- 1555-1377
- Volume :
- 38
- Database :
- MEDLINE
- Journal :
- The Iowa orthopaedic journal
- Publication Type :
- Academic Journal
- Accession number :
- 30104941