Outpatient spine surgery: defining the outcomes, value, and barriers to implementation

Neurosurg Focus. 2018 May;44(5):E11. doi: 10.3171/2018.2.FOCUS17790.

Abstract

Spine surgery is a key target for cost reduction within the United States health care system. One possible strategy involves the transition of inpatient surgeries to the ambulatory setting. Lumbar laminectomy with or without discectomy, lumbar fusion, anterior cervical discectomy and fusion, and cervical disc arthroplasty all represent promising candidates for outpatient surgeries in select populations. In this focused review, the authors clarify the different definitions used in studies describing outpatient spine surgery. They also discuss the body of evidence supporting each of these procedures and summarize the proposed cost savings. Finally, they examine several patient- and surgeon-specific considerations to highlight the barriers in translating outpatient spine surgery into actual practice.

Keywords: ACDF = anterior cervical discectomy and fusion; ambulatory surgery; anterior cervical discectomy and fusion; cervical disc arthroplasty; cost; lumbar laminectomy; minimally invasive surgery; outcomes; outpatient; transforaminal lumbar interbody fusion.

Publication types

  • Review

MeSH terms

  • Ambulatory Surgical Procedures / economics*
  • Ambulatory Surgical Procedures / methods*
  • Ambulatory Surgical Procedures / trends
  • Diskectomy / economics
  • Diskectomy / methods
  • Diskectomy / trends
  • Humans
  • Laminectomy / economics
  • Laminectomy / methods
  • Laminectomy / trends
  • Spinal Diseases / economics*
  • Spinal Diseases / surgery*
  • Spinal Fusion / economics
  • Spinal Fusion / methods
  • Spinal Fusion / trends
  • Treatment Outcome