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Multilevel Oblique Lumbar Interbody Fusion in Degenerative Lumbar Disc Disease with Instability
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Readmission Rate After 2-level Lumbar Decompression: A Propensity-matched Cohort Study Comparing Inpatient and

Ahmad Elsharydah1, Katherine L Duncan1, Eric B Rosero1

  • 1Departments of Anesthesiology and Pain Management.

Clinical Spine Surgery
|April 29, 2020
PubMed
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Ambulatory 2-level lumbar decompression shows similar 30-day readmission rates compared to inpatient procedures. However, outpatient spine surgery significantly reduces 30-day postoperative major complications, indicating potential benefits for patient recovery.

Area of Science:

  • Neurosurgery
  • Spine Surgery
  • Health Services Research

Background:

  • Increasing trend towards ambulatory spine surgery for lumbar decompression.
  • Concerns exist regarding readmission and postoperative morbidity after ambulatory spine procedures.
  • Need to evaluate safety and efficacy of ambulatory vs. inpatient settings for 2-level lumbar decompression.

Purpose of the Study:

  • Compare 30-day readmission and major complication rates for 2-level lumbar decompression in ambulatory vs. inpatient settings.
  • Assess the impact of surgical setting on patient outcomes after elective lumbar decompression.

Main Methods:

  • Retrospective review of the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database (2012-2015).
  • Matched 1:1 cohort analysis of adult patients undergoing elective 2-level lumbar decompression (CPT 63047/63048).

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  • Controlled for demographics, comorbidities, and procedure complexity; primary outcome: 30-day readmission; secondary outcomes: 30-day major complications, length of stay.

    • Main Results:

    • Significant increase in ambulatory 2-level lumbar decompression rates from 28% (2012) to 49% (2015).
    • No significant difference in 30-day readmission rates between ambulatory and inpatient cohorts (OR 0.82, P=0.097).
    • Ambulatory cohort demonstrated a significantly lower 30-day postoperative major complication rate (OR 0.55, P=0.002).

    Conclusions:

    • Elective 2-level lumbar decompression in the ambulatory setting is associated with similar 30-day readmission rates compared to inpatient procedures.
    • Ambulatory spine surgery for 2-level lumbar decompression leads to significantly lower 30-day postoperative major complication rates.
    • Further research is warranted to explore the underlying reasons for reduced complication rates in the ambulatory setting.