Comparison of Short-term Outcomes After Lumbar Fusion Between an Orthopedic Specialty Hospital and Tertiary Referral Center

Abstract

Study Design. A retrospective review of all elective single-level lumbar fusions performed at a single orthopedic specialty hospital (OSH) and tertiary referral center (TRC). Objective. This study compared the perioperative outcomes for lumbar fusion procedures performed at an OSH and TRC. Summary of Background Data. The role of an OSH for lumbar fusion procedures has not been defined. Methods. A large institutional database was searched for single-level lumbar fusions performed between 2013 and 2016. Comparisons were made between procedures performed at the OSH and TRC in terms of operative time, total operating room (OR) time, length of stay (LOS), inpatient rehabilitation utilization, postoperative 90-day readmission, reoperation, and mortality rates. Results. A total of 101 patients at the OSH and 481 at the TRC were included. There was no difference in gender, age, age adjusted Charlson comorbidity Index (AACCI), body mass index, mean number of concomitant levels decompressed, and use of interbody fusion between OSH and TRC patients. The mean operative time (149.5 vs. 179.7 minutes, P < 0.001), total OR time (195.1 vs. 247.9 minutes, P < 0.001), and postoperative LOS (2.61 vs. 3.73 days, P < 0.001) were significantly shorter at the OSH. More patients required postoperative inpatient rehabilitation at the TRC (7.1% vs. 2%, P < 0.001). There was no difference in 90-day readmission or reoperation rates. There was one mortality at the TRC and two patients required transfer from the OSH to the TRC due to medical complications. Regression analysis demonstrated that procedures performed at the TRC (P < 0.001), total OR time (P = 0.004), AACCI (P < 0.001), current smokers (P = 0.048), and number of decompressed levels (P = 0.032) were independent predictors of LOS. Conclusion. Lumbar fusion procedures may be safely performed at both the OSH and TRC. OSH utilization may demonstrate safe reduction in operative time, total OR time, and postoperative LOS in the appropriately selected patients. Level of Evidence: 3

Reimbursement of Lumbar Decompression at an Orthopedic Specialty Hospital Versus Tertiary Referral Center

“…Although discharge destination was not directly studied in this cohort, previous studies have shown that patients undergoing surgery at OSHs have a higher proportion of home discharge compared with tertiary care centers, thus avoiding further care costs. 6,25 It is possible that our study may be underpowered to detect a statistically significant difference for this particular reimbursement metric.…”

“…5 The average length of stay (LOS) has been shown to be 30% shorter among lumbar fusion patients at OSHs compared to patients undergoing surgery at academic medical centers. 6 Additionally, despite similar demographics and comorbidity indices, patients are more likely to be discharged to home rather than to rehabilitation facilities, which lowers the overall financial burden on the health system and decreases the rate of facility-associated complications. 6,7 Lastly, tertiary referral centers are associated with significantly higher overhead costs.…”

“…6 Additionally, despite similar demographics and comorbidity indices, patients are more likely to be discharged to home rather than to rehabilitation facilities, which lowers the overall financial burden on the health system and decreases the rate of facility-associated complications. 6,7 Lastly, tertiary referral centers are associated with significantly higher overhead costs. 8 Altogether, surgical centers offer the opportunity for comparably safe and effective patient care at a significantly reduced cost to the healthcare system.…”

What is the Ideal Neurosurgical or Orthopedic Specialty Hospital?

“…A study by Krietz, et al 2019, compared patients receiving a lumbar fusion in a orthopedic specialty hospital versus a tertiary referral center. The specialty hospital has statistically significant lower operative time, total operating room time, and length of stay when compared a tertiary referral center [15]. Specialty Hospitals brings numerous benefits directly to the patients and their families.…”

Orthopaedic Specialty Hospitals Compared with General Hospitals

“…Lundgren et al found no difference in readmission scores or complication scores, following THA and TKA, between physician-owned OSHs and acute-care hospitals 26 . The following 6 studies took place at the same institution and potentially showed results from the same hospitals 14,15,18,[22][23][24] . Padegimas et al reported no difference, following THA, in 90-day readmission rates between an OSH (0.6%) and a general hospital (1.5%) or reoperation rates between an OSH (0.9%) and a general hospital (1.2%).…”