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