A Comparison of 30-Day Hospital Readmission and Complication Rates After Outpatient Versus Inpatient 1 and 2 Level Anterior Cervical Discectomy and Fusion Surgery: An Analysis of a Medicare Patient Sample

Syed I. Khalid, Owoicho Adogwa, Amelia Ni, Joseph Cheng, Carlos A Bagley

Research output: Contribution to journalArticle

Abstract

Background: Same-day surgery has been demonstrated to be a safe and cost-effective alternative to traditional inpatient surgery. Several studies have demonstrated no differences in the postoperative complication profile or 30-day hospital readmission rates with outpatient versus inpatient anterior cervical discectomy and fusion (ACDF). However, none of these studies compared the outcomes in elderly patients (aged >65 years) undergoing ACDF. Whether the results from previous studies can be applied to this subgroup pf patients remains unknown. The aim of the present study was to compare the 30-day hospital readmission rates for Medicare patients (aged >65 years) undergoing outpatient versus inpatient ACDF. Methods: We performed a retrospective analysis of a Medicare database, including data from 17,421 patients. Of the 17,421 patients, 16,386 had undergone inpatient ACDF and 1035, outpatient ACDF. Age, sex, comorbidities, postoperative complications, readmission rates, and overall financial costs were compared between the 2 cohorts. Results: In a Medicare sample (aged >65 years), inpatient ACDF was associated with a greater incidence of postoperative complications compared with outpatient ACDF. Outpatient surgery was associated with significantly lower rates of postoperative complications (urinary tract infection, surgical site infection, deep vein thrombosis, pulmonary embolism, and myocardial infarction) and significantly lower treatment costs (P ≤ 0.001). All-cause 30-day hospital readmission rates were also greater for inpatients (10.1% vs. 4%; P = 0.17). Conclusion: The results from the present study suggest that outpatient ACDF appears to be safe and effective with low complication and readmission rates in a Medicare patient sample.

Original languageEnglish (US)
JournalWorld Neurosurgery
DOIs
StatePublished - Jan 1 2019

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Patient Readmission
Diskectomy
Medicare
Inpatients
Outpatients
Ambulatory Surgical Procedures
Pulmonary Infarction
Surgical Wound Infection
Costs and Cost Analysis
Pulmonary Embolism
Urinary Tract Infections
Venous Thrombosis
Health Care Costs
Comorbidity
Myocardial Infarction
Outcome Assessment (Health Care)
Databases
Incidence

Keywords

  • ACDF
  • Geriatric
  • Inpatient
  • Medicare
  • Outcomes
  • Outpatient
  • Readmission

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

@article{bca46f0771b94aaba114fc2d84df6b66,
title = "A Comparison of 30-Day Hospital Readmission and Complication Rates After Outpatient Versus Inpatient 1 and 2 Level Anterior Cervical Discectomy and Fusion Surgery: An Analysis of a Medicare Patient Sample",
abstract = "Background: Same-day surgery has been demonstrated to be a safe and cost-effective alternative to traditional inpatient surgery. Several studies have demonstrated no differences in the postoperative complication profile or 30-day hospital readmission rates with outpatient versus inpatient anterior cervical discectomy and fusion (ACDF). However, none of these studies compared the outcomes in elderly patients (aged >65 years) undergoing ACDF. Whether the results from previous studies can be applied to this subgroup pf patients remains unknown. The aim of the present study was to compare the 30-day hospital readmission rates for Medicare patients (aged >65 years) undergoing outpatient versus inpatient ACDF. Methods: We performed a retrospective analysis of a Medicare database, including data from 17,421 patients. Of the 17,421 patients, 16,386 had undergone inpatient ACDF and 1035, outpatient ACDF. Age, sex, comorbidities, postoperative complications, readmission rates, and overall financial costs were compared between the 2 cohorts. Results: In a Medicare sample (aged >65 years), inpatient ACDF was associated with a greater incidence of postoperative complications compared with outpatient ACDF. Outpatient surgery was associated with significantly lower rates of postoperative complications (urinary tract infection, surgical site infection, deep vein thrombosis, pulmonary embolism, and myocardial infarction) and significantly lower treatment costs (P ≤ 0.001). All-cause 30-day hospital readmission rates were also greater for inpatients (10.1{\%} vs. 4{\%}; P = 0.17). Conclusion: The results from the present study suggest that outpatient ACDF appears to be safe and effective with low complication and readmission rates in a Medicare patient sample.",
keywords = "ACDF, Geriatric, Inpatient, Medicare, Outcomes, Outpatient, Readmission",
author = "Khalid, {Syed I.} and Owoicho Adogwa and Amelia Ni and Joseph Cheng and Bagley, {Carlos A}",
year = "2019",
month = "1",
day = "1",
doi = "10.1016/j.wneu.2019.05.120",
language = "English (US)",
journal = "World Neurosurgery",
issn = "1878-8750",
publisher = "Elsevier Inc.",

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TY - JOUR

T1 - A Comparison of 30-Day Hospital Readmission and Complication Rates After Outpatient Versus Inpatient 1 and 2 Level Anterior Cervical Discectomy and Fusion Surgery

T2 - An Analysis of a Medicare Patient Sample

AU - Khalid, Syed I.

AU - Adogwa, Owoicho

AU - Ni, Amelia

AU - Cheng, Joseph

AU - Bagley, Carlos A

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Background: Same-day surgery has been demonstrated to be a safe and cost-effective alternative to traditional inpatient surgery. Several studies have demonstrated no differences in the postoperative complication profile or 30-day hospital readmission rates with outpatient versus inpatient anterior cervical discectomy and fusion (ACDF). However, none of these studies compared the outcomes in elderly patients (aged >65 years) undergoing ACDF. Whether the results from previous studies can be applied to this subgroup pf patients remains unknown. The aim of the present study was to compare the 30-day hospital readmission rates for Medicare patients (aged >65 years) undergoing outpatient versus inpatient ACDF. Methods: We performed a retrospective analysis of a Medicare database, including data from 17,421 patients. Of the 17,421 patients, 16,386 had undergone inpatient ACDF and 1035, outpatient ACDF. Age, sex, comorbidities, postoperative complications, readmission rates, and overall financial costs were compared between the 2 cohorts. Results: In a Medicare sample (aged >65 years), inpatient ACDF was associated with a greater incidence of postoperative complications compared with outpatient ACDF. Outpatient surgery was associated with significantly lower rates of postoperative complications (urinary tract infection, surgical site infection, deep vein thrombosis, pulmonary embolism, and myocardial infarction) and significantly lower treatment costs (P ≤ 0.001). All-cause 30-day hospital readmission rates were also greater for inpatients (10.1% vs. 4%; P = 0.17). Conclusion: The results from the present study suggest that outpatient ACDF appears to be safe and effective with low complication and readmission rates in a Medicare patient sample.

AB - Background: Same-day surgery has been demonstrated to be a safe and cost-effective alternative to traditional inpatient surgery. Several studies have demonstrated no differences in the postoperative complication profile or 30-day hospital readmission rates with outpatient versus inpatient anterior cervical discectomy and fusion (ACDF). However, none of these studies compared the outcomes in elderly patients (aged >65 years) undergoing ACDF. Whether the results from previous studies can be applied to this subgroup pf patients remains unknown. The aim of the present study was to compare the 30-day hospital readmission rates for Medicare patients (aged >65 years) undergoing outpatient versus inpatient ACDF. Methods: We performed a retrospective analysis of a Medicare database, including data from 17,421 patients. Of the 17,421 patients, 16,386 had undergone inpatient ACDF and 1035, outpatient ACDF. Age, sex, comorbidities, postoperative complications, readmission rates, and overall financial costs were compared between the 2 cohorts. Results: In a Medicare sample (aged >65 years), inpatient ACDF was associated with a greater incidence of postoperative complications compared with outpatient ACDF. Outpatient surgery was associated with significantly lower rates of postoperative complications (urinary tract infection, surgical site infection, deep vein thrombosis, pulmonary embolism, and myocardial infarction) and significantly lower treatment costs (P ≤ 0.001). All-cause 30-day hospital readmission rates were also greater for inpatients (10.1% vs. 4%; P = 0.17). Conclusion: The results from the present study suggest that outpatient ACDF appears to be safe and effective with low complication and readmission rates in a Medicare patient sample.

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KW - Geriatric

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KW - Medicare

KW - Outcomes

KW - Outpatient

KW - Readmission

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