Trends in Ambulatory Laminectomy in the USA and Key Factors Associated with Successful Same-Day Discharge: A Retrospective Cohort Study

Abstract

Background

Laminectomy is commonly used in the treatment of lumbar spine pathology. Laminectomies are increasingly being performed in outpatient settings, but patient safety concerns remain.

Questions/Purposes

We aimed to describe trends in outpatient lumbar laminectomy between 2008 and 2016 and to identify factors associated with successful same-day discharge.

Methods

We identified patients who underwent single-level lumbar laminectomy between 2008 and 2016 in the American College of Surgeons’ National Surgical Quality Improvement Program database and divided them into two groups according to their admission status, either inpatient or outpatient. Inpatient and outpatient groups were further divided according to actual length of stay (LOS): did not remain in the hospital overnight (LOS = 0) or stayed in the hospital overnight or longer (LOS ≥ 1). We then analyzed patient characteristics and complications for significance and to identify factors associated with successful same-day discharge.

Results

We identified 85,769 patients, 41,149 classified as outpatient status and 44,620 as inpatient status. Between 2008 and 2016, the proportion of procedures performed on an outpatient basis increased from 24.1 to 56.74%. Overall, 27.3% of all patients were discharged on the day of surgery, representing 52.8% of outpatients and 3.8% of inpatients. Older age and longer duration of surgery predicted that patients were less likely to have same-day discharge. Patients with a primary diagnosis other than intervertebral disk disorder, Hispanic ethnic background, or an American Society of Anesthesiologists physical status classification of III were less likely to achieve same-day discharge. Patients under the care of orthopedic surgeons (as opposed to neurosurgeons) were more likely to be discharged on the day of surgery. We also found an association between sex and day of discharge, with female patients being less likely to be discharged on the day of surgery.

Conclusions

Laminectomy is increasingly being performed in the outpatient setting. Younger, healthier non-Hispanic male patients undergoing uncomplicated surgery have a higher likelihood of successful same-day discharge.

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References

  1. 1.

    Aldebeyan S, Aoude A, Fortin M, et al. Predictors of discharge destination after lumbar spine fusion surgery. Spine (Phila Pa 1976). 2016;41(19):1535–1541.

    Article  Google Scholar 

  2. 2.

    An HS, Simpson JM, Stein R. Outpatient laminotomy and discectomy. J Spinal Disord. 1999;12(3):192–196.

    CAS  PubMed  Google Scholar 

  3. 3.

    Baird EO, Brietzke SC, Weinberg AD, et al. Ambulatory spine surgery: a survey study. Global Spine J. 2014;4(3):157–160.

    Article  Google Scholar 

  4. 4.

    Basques BA, Fu MC, Buerba RA, Bohl DD, Golinvaux NS, Grauer JN. Using the ACS-NSQIP to identify factors affecting hospital length of stay after elective posterior lumbar fusion. Spine (Phila Pa 1976)\. 2014;39(6):497–502.

    Article  Google Scholar 

  5. 5.

    Basques BA, Hijji FY, Khechen B, et al. Sex differences for anterior cervical fusion: complications and length of stay. Spine (Phila Pa 1976). 2017;43(15):1025–1030.

    Google Scholar 

  6. 6.

    Best NM, Sasso RC. Success and safety in outpatient microlumbar discectomy. J Spinal Disord Tech. 2006;19(5):334–337.

    Article  Google Scholar 

  7. 7.

    Best NM, Sasso RC. Outpatient lumbar spine decompression in 233 patients 65 years of age or older. Spine (Phila Pa 1976). 2007;32(10):1135–1139; discussion 1140.

    Article  Google Scholar 

  8. 8.

    Bumpass DB, Lenke LG, Gum JL, et al. Male sex may not be associated with worse outcomes in primary all-posterior adult spinal deformity surgery: a multicenter analysis. Neurosurg Focus. 2017;43(6):E9.

    Article  Google Scholar 

  9. 9.

    Deyo RA, Mirza SK. Trends and variations in the use of spine surgery. Clin Orthop Relat Res. 2006;443:139–146.

    Article  Google Scholar 

  10. 10.

    Deyo RA, Gray DT, Kreuter W, Mirza S, Martin BI. United States trends in lumbar fusion surgery for degenerative conditions. Spine (Phila Pa 1976). 2005;30(12):1441–1445; discussion 1446–1447.

    Article  Google Scholar 

  11. 11.

    Deyo RA, Mirza SK, Martin BI, Kreuter W, Goodman DC, Jarvik JG. Trends, major medical complications, and charges associated with surgery for lumbar spinal stenosis in older adults. JAMA. 2010;303(13):1259–1265.

    CAS  Article  Google Scholar 

  12. 12.

    Elsamadicy AA, Reddy GB, Nayar G, et al. Impact of gender disparities on short-term and long-term patient reported outcomes and satisfaction measures after elective lumbar spine surgery: a single institutional study of 384 patients. World Neurosurg. 2017;107:952–958.

    Article  Google Scholar 

  13. 13.

    Farshad M, Bauer DE, Wechsler C, Gerber C, Aichmair A. Risk factors for perioperative morbidity in spine surgeries of different complexities: a multivariate analysis of 1009 consecutive patients. Spine J. 2018; 18(9)1625–1631.

    Article  Google Scholar 

  14. 14.

    Gan TJ, Diemunsch P, Habib AS, et al. Consensus guidelines for the management of postoperative nausea and vomiting. Anesth Analg. 2014;118(1):85–113.

    Article  Google Scholar 

  15. 15.

    Gray DT, Deyo RA, Kreuter W, et al. Population-based trends in volumes and rates of ambulatory lumbar spine surgery. Spine (Phila Pa 1976). 2006;31(17):1957–1963; discussion 1964.

    Article  Google Scholar 

  16. 16.

    Gray DT, Hollingworth W, Onwudiwe N, Jarvik JG. Costs and state-specific rates of thoracic and lumbar vertebroplasty, 2001-2005. Spine (Phila Pa 1976). 2008;33(17):1905–1912.

    Article  Google Scholar 

  17. 17.

    Idowu OA, Boyajian HH, Ramos E, Shi LL, Lee MJ. Trend of spine surgeries in the outpatient hospital setting versus ambulatory surgical center. Spine (Phila Pa 1976). 2017;42(24):E1429–E1436.

    Article  Google Scholar 

  18. 18.

    Kim BD, Smith TR, Lim S, Cybulski GR, Kim JY. Predictors of unplanned readmission in patients undergoing lumbar decompression: multi-institutional analysis of 7016 patients. J Neurosurg Spine. 2014;20(6):606–616.

    Article  Google Scholar 

  19. 19.

    Lurie JD, Tosteson TD, Tosteson A, et al. Long-term outcomes of lumbar spinal stenosis: eight-year results of the Spine Patient Outcomes Research Trial (SPORT). Spine (Phila Pa 1976). 2015;40(2):63–76.

    Article  Google Scholar 

  20. 20.

    Mancuso CA, Duculan R, Craig CM, Girardi FP. Psychosocial variables contribute to length of stay and discharge destination after lumbar surgery independent of demographic and clinical variables. Spine (Phila Pa 1976). 2018;43(4):281–286.

    Article  Google Scholar 

  21. 21.

    McCutcheon BA, Ciacci JD, Marcus LP. Thirty-day perioperative outcomes in spinal fusion by specialty within the NSQIP database. Spine (Phila Pa 1976). 2015;40(14):1122–1131.

    Article  Google Scholar 

  22. 22.

    Minhas SV, Chow I, Patel AA, Kim JY. Surgeon specialty differences in single-level anterior cervical discectomy and fusion. Spine (Phila Pa 1976). 2014;39(20):1648–1655.

    Article  Google Scholar 

  23. 23.

    Murphy ME, Gilder H, Maloney PR, et al. Lumbar decompression in the elderly: increased age as a risk factor for complications and nonhome discharge. J Neurosurg Spine. 2017;26(3):353–362.

    Article  Google Scholar 

  24. 24.

    Newman MH. Outpatient conventional laminotomy and disc excision. Spine (Phila Pa 1976). 1995;20(3):353–355.

    CAS  Article  Google Scholar 

  25. 25.

    Nie H, Hao J, Peng C, Ou Y, Quan Z, An H. Clinical outcomes of discectomy in octogenarian patients with lumbar disc herniation. J Spinal Disord Tech. 2013;26(2):74–78.

    Article  Google Scholar 

  26. 26.

    Phan K, Kim JS, Kim JH, et al. Anesthesia duration as an independent risk factor for early postoperative complications in adults undergoing elective ACDF. Global Spine J. 2017;7(8):727–734.

    Article  Google Scholar 

  27. 27.

    Pugely AJ, Martin CT, Gao Y, Mendoza-Lattes S. Causes and risk factors for 30-day unplanned readmissions after lumbar spine surgery. Spine (Phila Pa 1976). 2014;39(9):761–768.

    Article  Google Scholar 

  28. 28.

    Seicean A, Alan N, Seicean S, Neuhauser D, Benzel EC, Weil RJ. Surgeon specialty and outcomes after elective spine surgery. Spine (Phila Pa 1976). 2014;39(19):1605–1613.

    Article  Google Scholar 

  29. 29.

    Shapiro FE, Punwani N, Urman RD. Office-based surgery: embracing patient safety strategies. J Med Pract Manage. 2013;29(2):72–75.

    PubMed  Google Scholar 

  30. 30.

    Siemionow K, Pelton MA, Hoskins JA, Singh K. Predictive factors of hospital stay in patients undergoing minimally invasive transforaminal lumbar interbody fusion and instrumentation. Spine (Phila Pa 1976). 2012;37(24):2046–2054.

    Article  Google Scholar 

  31. 31.

    Smith WD, Wohns RN, Christian G, Rodgers EJ, Rodgers WB. Outpatient minimally invasive lumbar interbody: fusion predictive factors and clinical results. Spine (Phila Pa 1976). 2016;41 Suppl 8:S106–S122.

    Google Scholar 

  32. 32.

    Somani S, Capua JD, Kim JS, et al. ASA classification as a risk stratification tool in adult spinal deformity surgery: a study of 5805 patients. Global Spine J. 2017;7(8):719–726.

    Article  Google Scholar 

  33. 33.

    Wadhwa RK, Ohya J, Vogel TD, et al. Risk factors for 30-day reoperation and 3-month readmission: analysis from the quality and outcomes database lumbar spine registry. J Neurosurg Spine. 2017;27(2):131–136.

    Article  Google Scholar 

  34. 34.

    Weinstein JN, Lurie JD, Tosteson TD, et al. Surgical versus nonoperative treatment for lumbar disc herniation: four-year results for the Spine Patient Outcomes Research Trial (SPORT). Spine (Phila Pa 1976). 2008;33(25):2789–2800.

    Article  Google Scholar 

  35. 35.

    Wohns R. Safety and cost-effectiveness of outpatient cervical disc arthroplasty. Surg Neurol Int. 2010;1:77.

    Article  Google Scholar 

  36. 36.

    Zheng F, Cammisa FP Jr., Sandhu HS, Girardi FP, Khan SN. Factors predicting hospital stay, operative time, blood loss, and transfusion in patients undergoing revision posterior lumbar spine decompression, fusion, and segmental instrumentation. Spine (Phila Pa 1976). 2002;27(8):818–824.

    Article  Google Scholar 

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Corresponding author

Correspondence to Jiabin Liu MD, PhD.

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Conflict of Interest

Ellen M. Soffin, MD, PhD, James D. Beckman, MD, Jonathan C. Beathe, MD, Gregory A. Liguori, MD, and Jiabin Liu, MD, PhD, declare that they have no conflicts of interest. Federico P. Girardi, MD, reports royalties from Lanx, Inc., Depuy Synthes Spine, Nuvasive, Inc., and Ortho Development Corp.; fees as a consultant from Ortho Development Corp., Spineart USA, Nuvasive, Inc., Depuy Synthes Spine, Lanx, Inc., and EIT Emerging Implant Technologies; ownership interest in Healthpoint Capital Partners, Paradigm Spine, LLC, Centinel Spine, Inc., Spinal Kinetics, Inc., and Liventa Bioscience; and other personal fees from Aesculap, MiMedx Group, Inc., and Nuvasive, Inc., outside the submitted work.

Human/Animal Rights

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2013.

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Informed consent was waived from all patients for being included in this study.

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Level of Evidence: Level III: Retrospective cohort study

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Soffin, E.M., Beckman, J.D., Beathe, J.C. et al. Trends in Ambulatory Laminectomy in the USA and Key Factors Associated with Successful Same-Day Discharge: A Retrospective Cohort Study. HSS Jrnl 16, 72–80 (2020). https://doi.org/10.1007/s11420-019-09703-0

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Keywords

  • ambulatory
  • laminectomy
  • trend of practice
  • predictor
  • same-day discharge