Samuel hassenbusch young neurosurgeon award 139 anterior cervical diskectomy and fusion in the ambulatory care setting: defining its value across the acute and post-acute care episode.

INTRODUCTION: In the era of current healthcare reforms, all stakeholders have adopted value-based purchasing strategies to shift care toward higher benefit and lower cost treatment approaches. Degenerative spine disease is highly prevalent and its surgical intervention costly. In this study, we set out to quantify the potential cost savings and patient-centered benefits associated with performing anterior cervical diskectomy and fusion (ACDF) in an ambulatory surgery center vs inpatient hospital setting.

METHODS: One hundred twelve consecutive cases of 1 or 2-level ACDF performed at 2 centers were prospectively enrolled into a common registry. Data were collected on patient demographics, operative details and perioperative and 90-day morbidity. Ninety-day morbidity, return to work, and 3-month patient reported outcomes were prospectively assessed. Direct costs were estimated from resource utilization via macro-costing with private pay estimated as 1.7xMedicare fee schedule. Indirect costs were calculated from lost work productivity using standard human capital approach.

RESULTS: Fifty-three outpatient ACDF and 59 inpatient ACDF patients were included. Cohorts were similar at baseline. Ninety-day surgical morbidity was similar between outpatient vs inpatient cohorts: 30-day readmission (0.0% vs 1.7%; P = .34), 90-day readmission (0.0% vs 1.7%; P = .34), deep venous thrombosis (0.0% vs 1.7%; P = .34), dysphagia requiring nil per os/nasogastric tube (0.0% vs 1.7%; P = .34) and neck hematoma (0.0% vs 1.7%; P = .34) (Table 1). Improvement in 3-month pain, disability, quality of life, and return to work were also similar between 2 cohorts (Figures 1 and 2). Mean total 3-month cost per patient was significantly reduced in the outpatient vs inpatient surgery cohort ($20 043 vs $27 123; P < .001) with similar quality-adjusted life year -gained (Table 2).

CONCLUSION: During the acute care and post-acute care episode, the outpatient ambulatory care vs inpatient hospital setting was associated with significant cost savings without a compromise in safety or clinical effectiveness for ACDF. From a patient, payer, purchaser, and societal perspective, the ambulatory surgery center setting offers superior value and can lead to cost savings of over $7000 per patient.