Advance Access: Outpatient vs Inpatient Anterior Cervical Discectomy and Fusion: A Population-Level Analysis of Outcomes and Cost

Spine surgery represents an ideal target for cost reduction within the United States healthcare system due to increasing utilization1 and high payer costs in the face of an aging population.2 One dramatic strategy involves shifting traditionally inpatient procedures to the ambulatory setting. Surgeries performed in an inpatient or hospital-based encounter are estimated to cost 2 to 3 times more than those conducted in an ambulatory surgery center.3

Anterior cervical discectomy and fusion (ACDF) has been identified as a promising candidate to be transitioned into the outpatient setting, given that it is a common procedure that has been shown in the literature to have a low complication rate and early patient discharge in many cases.4-14

Before this cost-reduction strategy can be widely adopted, outpatient ACDF must demonstrate “noninferiority” and produce equivalent or superior outcomes while maintaining patient satisfaction and reducing cost.15,16

The Healthcare Cost and Utilization Project (HCUP) provides state-level encounter and clinical data for all ambulatory, inpatient, and emergency department visits. We retrospectively studied demographics, 30-d outcomes, cost, and predictors of readmission and reoperation after 1- and 2-level ACDF performed in an inpatient and ambulatory setting in 3 highly populated states over a 3-yr period.

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