Outcomes of Same-Day Orthopedic Surgery: Are Spine Patients More Likely to Have Optimal Immediate Recovery From Outpatient Procedures?

Abstract

Background: Spinal surgery is associated with an inherently elevated risk profile, and thus far there has been limited discussion about how these outpatient spine patients are benefiting from these same-day procedures against other typical outpatient orthopedic surgeries.Methods: Orthopedic patients who received either inpatient or outpatient surgery were isolated in the American College of Surgeons National Surgical Quality of Improvement Program (2005Program ( -2016. Patients were stratified by type of orthopedic surgery received (spine, knee, ankle, shoulder, or hip). Mean comparisons and chi-squared tests assessed basic demographics. Perioperative complications were analyzed via regression analyses in regard to their principal inpatient or outpatient orthopedic surgery received.Results: This study included 729 480 surgical patients: 32.5% received spinal surgery, 36.5% knee, 24.1% hip, 4.9% shoulder, and 1.7%ankle. Of those who received a spinal procedure, 74.7% were inpatients (IN), and 25.3% were outpatients (OUT): knee: 96.1% IN, 3.9% OUT; hip:98.9% IN, 1.1% OUT; ankle: 29% IN, 71% OUT; and shoulder: 52.6% IN, 47.6% OUT. Hip patients were the oldest, and knee patients had the highest body mass index out of the orthopedic groups (P , .00). Spine IN patients experienced more complications than the other orthopedic groups and had the lowest OUT complications(both P , .05). This same trend of having higher IN complications than OUT complications was identified for hip, shoulder, and knee. However, ankle procedures had greater OUT procedure complications than IN (P , .05). After controlling for age, body mass index, and Charlson Comorbidity Index, IN procedures, such as knee, hip, spine, and shoulder, were significantly associated with experiencing postoperative complications. From 2006 to 2016, IN and OUT surgeries were significantly different among complications experienced for all of the orthopedic groups (P , .05) with complications decreasing for IN and OUT patients by 2016.Conclusions: Over the past decade, spine surgery has decreased in complications for IN and OUT procedures along with IN/OUT knee, ankle, hip, and shoulder procedures, reflecting greater tolerance for risk in an outpatient setting.Level of Evidence: 3. Clinical Relevance: Despite the increase in riskier spine procedures, complications have decreased over the years. Surgeons should aim to continue to decrease inpatient spine complications to the level of other orthopedic surgeries.

Increase in surgeons performing outpatient anterior cervical spine surgery leads to a shift in case volumes over time

“…There has been a gradual movement towards anterior cervical spine surgery being performed in outpatient settings as opposed to inpatient settings [1] , [2] , [3] , [4] , [5] . This trend has been observed for a number of orthopedic procedures, as outpatient surgery is associated with significant cost reduction relative to inpatient surgery due to lower length of in-hospital stay and less perioperative morbidity [6] , [7] , [8] . However, the transition to the outpatient setting for anterior cervical spine surgery is controversial due to concern regarding complications, particularly airway compromise or spinal cord compression following postoperative hematoma formation [9] , [10] , [11] .…”

Database analysis comparing incidence and complication rates between inpatient and outpatient laminotomies for lumbar disc herniation

“…Recent literature has reported an increased shift to performing various spinal surgeries, including cervical and lumbar fusions, to an outpatient setting [ 14 , 17 ]. This is in large part due to cost reduction and decreased perioperative morbidity relative to inpatient surgery [ 15 ].…”