What question did this study set out to answer?

The aim is to compare outcomes and healthcare usage of single-level ALIF and LLIF in inpatient versus outpatient settings.

April 1, 2026

Shifting Single-level Anterior and Lateral Lumbar Interbody Fusion to the Ambulatory Setting

Q: What does this research mean for the field?

Outpatient single-level anterior and lateral lumbar interbody fusion (ALIF/LLIF) is associated with lower rates of complications, emergency department visits, hospital readmissions, and total reimbursements compared to inpatient procedures, demonstrating its safety and cost-efficiency in appropriately selected patients. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Key Points

The aim is to compare outcomes and healthcare usage of single-level ALIF and LLIF in inpatient versus outpatient settings.
Conducted a retrospective review of the PearlDiver database from 2010 to 2022.
Matched inpatient and outpatient cohorts based on age, gender, and comorbidity.
Assessed various outcomes including complications and reimbursements.
Outpatient ALIF/LLIF had significantly lower rates of intraoperative and 90-day complications.
Outpatient patients showed fewer emergency department visits and readmissions at 30 and 90 days post-surgery.
Higher revision-free survival at 5 years was observed in the outpatient group.
Day-of-surgery reimbursements were lower for outpatient procedures compared to inpatient.

Abstract

Study Design. Retrospective cohort study Objective. To compare outcomes and healthcare utilization between single-level anterior lumbar interbody fusion (ALIF) or lateral lumbar interbody fusion (LLIF) performed in inpatient and outpatient settings Summary of Background Data. As healthcare costs continue to rise, there has been a corresponding increase in the number of spine surgeries performed in ambulatory surgery centers. ALIF/LLIF are among the most commonly performed minimally invasive lumbar spine procedures. Large-scale data reporting on outcomes following outpatient ALIF/LLIF remains limited. Methods. A retrospective review of the PearlDiver database was conducted, querying for single-level ALIF/LLIF from 2010 to 2022 stratified by service location. Inpatient and outpatient cohorts were matched 1: 1 on age range, gender, and the Elixhauser Comorbidity Index (ECI). Outcomes assessed included intraoperative complications, 90-day medical and surgical complications, 30-day and 90-day emergency department (ED) visits and inpatient readmissions, day-of-surgery and 90-day global reimbursements, and five-year revision-free survival. Results. A total of 8, 342 patients who underwent outpatient ALIF/LLIF were matched to 8, 342 patients who underwent inpatient procedures. Inpatient ALIF/LLIFs were associated with significantly higher rates of intraoperative and 90-day postoperative complications. Patients in the outpatient group were less likely to present to the ED or require hospital readmission at both 30 and 90 days postoperatively (P <0. 001 for all) and demonstrated higher revision-free survival at 5 years (log-rank P =0. 007). Outpatient procedures were associated with significantly lower reimbursements on the day of surgery (Median IQR: 3, 199 1, 270-6, 402 vs. 3, 942 1, 694-9, 433, P <0. 001) and within 90 days postoperatively (Median IQR: 5, 169 2, 535-9, 480 vs. 6, 779 3, 407-15, 034, P <0. 001) ) Conclusion. Outpatient ALIF/LLIF procedures are associated with significantly lower rates of postoperative ED visits, hospital readmissions, and total reimbursements compared to inpatient ALIF/LLIF, without an increased risk of complications. These findings support the safety and cost-efficiency of outpatient ALIF/LLIF in appropriately selected patients.

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Cite This Study

Green et al. (Fri,) studied this question.

synapsesocial.com/papers/69ccb66716edfba7beb87fc4 https://doi.org/https://doi.org/10.1097/brs.0000000000005701

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