Trends in Utilization and Cost of Endoscopic Lumbar Decompression in Ambulatory Surgical Centers: A Nationwide Database Analysis From 2018 Through 2022

Study Design Retrospective cohort study. Objectives This study aimed to examine national trends in utilization, charges, and patient characteristics associated with endoscopic spine surgery (ESS) in ambulatory surgery centers (ASCs) from 2018 to 2022. Methods The Nationwide Ambulatory Surgery Sample (NASS) was queried for adult encounters identified by Current Procedural Terminology code 62380. Cases with valid weights and complete charge, payer, region (defined as HCUP U.S. Census regions), and month data were retained. Facility charges were inflation-adjusted to 2022 USD and winsorized at the 1st and 99th percentiles. Survey-weighted models estimated differences in charges and temporal trends, with pairwise comparisons from estimated marginal means. Significance was set at the P < 0.05 level. Results A total of 3097 ESS procedures were analyzed. Most were performed in urban settings (93.5%) and among patients in the highest income quartile (34.6%). Private insurance was the most common payer (47.8%), though self-pay utilization rose from 0.8% in 2018 to 9.7% in 2022 ( P < 0.001). Costs varied significantly by payer and region, with self-pay patients incurring the highest charges ($70,000; P < 0.001) and the West recording the highest regional costs ($68,700; P < 0.001). Procedure volume increased in the West — from 4.3% of national volume in 2018 to 31.0% in 2022 ( P < 0.001). Conclusions ESS in ASCs exhibited rapid procedural growth, particularly in the Western U.S., alongside substantial payer and region-specific variation in cost. These findings highlight the need for continued evaluation of access and reimbursement equity as ESS expands nationally.