Lumbar Laminectomy in the Outpatient Setting Is Associated With Lower 30-Day Complication Rates

Karukonda, Teja; Mancini, Nickolas; Katz, Amiram; Cote, Mark P.; Moss, Isaac L.

doi:10.1177/2192568219850095

Cited by 13 publications

(17 citation statements)

References 29 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…With the overall complications and readmissions within 90 days not being significantly different between the two cohorts, the present study clearly demonstrates that in appropriately selected patients, performing surgery at the OSH can lower the cost to the health care system. 24 This study is not without limitations. First, this is a retrospective analysis which does not control for selection bias.…”

Section: Discussionmentioning

confidence: 89%

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

Kothari

Canseco

Karamian

et al. 2021

Spine

View full text Add to dashboard Cite

Study Design. Retrospective cohort study.Objective. The aim of this study was to investigate the differences in Medicare reimbursement for one-to three-level lumbar decompression procedures performed at a tertiary referral center versus an orthopedic specialty hospital (OSH). Summary of Background Data. Lumbar decompression surgery is one of the most commonly performed spinal procedures. Lumbar decompression also comprises the largest proportion of spinal surgery that has transitioned to the outpatient setting. Methods. Patients who underwent a primary one-to three-level lumbar decompression were retrospectively identified. Reimbursement data for a tertiary referral center and an OSH were compiled through Centers for Medicare and Medicaid Services. Demographic data, surgical characteristics, and time cost data were collected through chart review. Multivariate regression models were used to determine independent factors associated with total episode of care cost, operating room (OR) time, procedure time, and length of stay (LOS), and to determine independent predictors of having the decompression performed at the OSH. Results. Total episode of care, facility, and non-facility payments were significantly greater at the tertiary referral center than the OSH, as were OR time for one-to three-level procedures, procedure time of all pooled levels, and LOS for one-and two-level procedures. Three-level procedure was independently associated with increased OR time, procedure time, and LOS. Age and two-level procedure were also associated with increased LOS. Procedure at the OSH was associated with decreased OR time and LOS. Charlson Comorbidity Index was a negative predictor of decompression being performed in the OSH setting. Conclusion. Significant financial savings to health systems can be expected when performing lumbar decompression surgery at a specialty hospital as opposed to a tertiary referral center. Patients who are appropriate candidates for surgery in an OSH can in turn expect faster perioperative times and shorter LOS.

show abstract

Section: Discussionmentioning

confidence: 89%

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

Kothari

Canseco

Karamian

et al. 2021

Spine

View full text Add to dashboard Cite

show abstract

“…Given the 7% complication rate after in-patient laminectomy, postoperative imaging to assess for persistence of pathology and/or new complications is not uncommon. 3 MRI is the modality of choice, given that specific imaging features are diagnostic of specific complications. 12 SEAs are an indication for decompressive surgery as well as a possible serious complication of surgery.…”

Section: Discussionmentioning

confidence: 99%

“…1,2 Overall, in-patient laminectomy surgery has a 30-day complication rate of 7%. 3 Postoperative complications include soft tissue collections like a hematoma, a persistent and/or new abscess, or a spinal fluid collection caused by a dural tear. 4,5 The most sensitive modality for diagnosis of postoperative spinal complications is gadolinium-enhanced magnetic resonance imaging (MRI); for example, paraspinal or epidural inflammation on MRI with contrast is 97% sensitive for an SEA.…”

mentioning

confidence: 99%

Gray-Scale Sonography of the Spinal Cord in Postlaminectomy Patient

Juneja

Frenkel

Carmichael

et al. 2021

Journal of Diagnostic Medical Sonography

View full text Add to dashboard Cite

Laminectomy, a common neurosurgical procedure that decompresses the spinal cord, is the definitive surgical treatment for spinal epidural abscesses. Although complications after laminectomy occur infrequently, they can cause significant morbidity and health care resource usage. These complications include soft tissue collections like a persistent and/or new abscess or a hematoma. The preferred method of diagnosis for spinal soft tissue collections is magnetic resonance imaging. However, traditional neuroimaging poses significant challenges in patients with spinal hardware due to metallic artifact precluding appropriate visualization of anatomy and pathology. This was a case of a patient with extensive spinal hardware where visualization of the spinal cord by postoperative sonography was made feasible by a lack of bone after a laminectomy. Point-of-care ultrasound, a convenient bedside tool with the ability to detect soft tissue collections easily, was used to monitor for postoperative recurrence of a spinal epidural abscess in this patient. Patients with an intact spine do not have adequate acoustic windows due to posterior vertebral anatomy. In postlaminectomy patients without posterior vertebral structures, sonography may offer a diagnostic modality for postoperative monitoring. Ultrasonographers can employ spinal cord sonography, particularly when the indication for decompressive laminectomy was a localized fluid collection or abscess.

show abstract

“…It is noteworthy that the mean LOS for patients undergoing decompression alone in our analysis was only 0.41 days shorter than that of patients undergoing decompression with fusion (2.55 days vs 2.96 days); in contrast, in a metaanalysis of major studies regarding difference in LOS, 12 the estimated difference was approximately 1.7 days. While definitive national data are lacking, the rate of outpatient decompression among all decompression procedures is likely 50% to 60% 29,30 ; furthermore, there is no evidence that the relative proportion of outpatient decompression procedures has been increasing over time. 29,30 The patterns identified in our analysis were not subtle or ambiguous.…”

Section: Jama Network Open | Surgerymentioning

confidence: 99%

Patterns in Decompression and Fusion Procedures for Patients With Lumbar Stenosis After Major Clinical Trial Results, 2016 to 2019

et al. 2023

View full text Add to dashboard Cite

ImportanceUse of lumbar fusion has increased substantially over the last 2 decades. For patients with lumbar stenosis and degenerative spondylolisthesis, 2 landmark prospective randomized clinical trials (RCTs) published in the New England Journal of Medicine in 2016 did not find clear evidence in favor of decompression with fusion over decompression alone in this population.ObjectiveTo assess the national use of decompression with fusion vs decompression alone for the surgical treatment of lumbar stenosis and degenerative spondylolisthesis from 2016 to 2019.Design, Setting, and ParticipantsThis retrospective cohort study included 121 745 hospitalized adult patients (aged ≥18 years) undergoing 1-level decompression alone or decompression with fusion for the management of lumbar stenosis and degenerative spondylolisthesis from January 1, 2016, to December 31, 2019. All data were obtained from the National Inpatient Sample (NIS). Analyses were conducted, reviewed, or updated on June 9, 2023.Main Outcome and MeasureThe primary outcome of this study was the use of decompression with fusion vs decompression alone. For the secondary outcome, multivariable logistic regression analysis was used to evaluate factors associated with the decision to perform decompression with fusion vs decompression alone.ResultsAmong 121 745 eligible hospitalized patients (mean age, 65.2 years [95% CI, 65.0-65.4 years]; 96 645 of 117 640 [82.2%] non-Hispanic White) with lumbar stenosis and degenerative spondylolisthesis, 21 230 (17.4%) underwent decompression alone, and 100 515 (82.6%) underwent decompression with fusion. The proportion of patients undergoing decompression alone decreased from 2016 (7625 of 23 405 [32.6%]) to 2019 (3560 of 37 215 [9.6%]), whereas the proportion of patients undergoing decompression with fusion increased over the same period (from 15 780 of 23 405 [67.4%] in 2016 to 33 655 of 37 215 [90.4%] in 2019). In univariable analysis, patients undergoing decompression alone differed significantly from those undergoing decompression with fusion with regard to age (mean, 68.6 years [95% CI, 68.2-68.9 years] vs 64.5 years [95% CI, 64.3-64.7 years]; P &lt; .001), insurance status (eg, Medicare: 13 725 of 21 205 [64.7%] vs 53 320 of 100 420 [53.1%]; P &lt; .001), All Patient Refined Diagnosis Related Group risk of death (eg, minor risk: 16 900 [79.6%] vs 83 730 [83.3%]; P &lt; .001), and hospital region of the country (eg, South: 7030 [33.1%] vs 38 905 [38.7%]; Midwest: 4470 [21.1%] vs 23 360 [23.2%]; P &lt; .001 for both comparisons). In multivariable logistic regression analysis, older age (adjusted odds ratio [AOR], 0.96 per year; 95% CI, 0.95-0.96 per year), year after 2016 (AOR, 1.76 per year; 95% CI, 1.69-1.85 per year), self-pay insurance status (AOR, 0.59; 95% CI, 0.36-0.95), medium hospital size (AOR, 0.77; 95% CI, 0.67-0.89), large hospital size (AOR, 0.76; 95% CI, 0.67-0.86), and highest median income quartile by patient residence zip code (AOR, 0.79; 95% CI, 0.70-0.89) were associated with lower odds of undergoing decompression with fusion. Conversely, hospital region in the Midwest (AOR, 1.34; 95% CI, 1.14-1.57) or South (AOR, 1.32; 95% CI, 1.14-1.54) was associated with higher odds of undergoing decompression with fusion. Decompression with fusion vs decompression alone was associated with longer length of stay (mean, 2.96 days [95% CI, 2.92-3.01 days] vs 2.55 days [95% CI, 2.49-2.62 days]; P &lt; .001), higher total admission costs (mean, $30 288 [95% CI, $29 386-$31 189] vs $16 190 [95% CI, $15 189-$17 191]; P &lt; .001), and higher total admission charges (mean, $121 892 [95% CI, $119 566-$124 219] vs $82 197 [95% CI, $79 745-$84 648]; P &lt; .001).Conclusions and RelevanceIn this cohort study, despite 2 prospective RCTs that demonstrated the noninferiority of decompression alone compared with decompression with fusion, use of decompression with fusion relative to decompression alone increased from 2016 to 2019. A variety of patient- and hospital-level factors were associated with surgical procedure choice. These results suggest the findings of 2 major RCTs have not yet produced changes in surgical practice patterns and deserve renewed focus.

show abstract

Lumbar Laminectomy in the Outpatient Setting Is Associated With Lower 30-Day Complication Rates

Cited by 13 publications

References 29 publications

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

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

Gray-Scale Sonography of the Spinal Cord in Postlaminectomy Patient

Patterns in Decompression and Fusion Procedures for Patients With Lumbar Stenosis After Major Clinical Trial Results, 2016 to 2019

Contact Info

Product

Resources

About