176. Safety profile of outpatient anterior lumbar interbody and fusion: a propensity score matched analysis

Abstract

BACKGROUND CONTEXT Anterior lumbar interbody fusion (ALIF) has been shown to reduce postoperative blood loss and result in superior radiological outcomes compared to the traditional posterior approach. While several studies have analyzed outpatient spine procedures, only a few small institutional cohort studies have specifically evaluated postoperative complications of ALIF in the outpatient setting. PURPOSE The aim of this investigation was to 1) identify independent factors contributing to complications after outpatient ALIF 2), evaluate differences in short-term (24 hour) and 90-day medical and surgical outcomes following outpatient ALIF and 3) compare the 90-day financial burden associated with outpatient vs inpatient ALIF. STUDY DESIGN/SETTING Retrospective review. PATIENT SAMPLE A total of 1,768 patients undergoing outpatient single level ALIF and 7,339 patients were identified undergoing multilevel ALIF. OUTCOME MEASURES Outpatient single-level ALIF study patients were compared to their respective control populations for short-term complications, 90-day major and minor medical complications and readmissions. Short term complications tracked included intraoperative dural tear, urinary retention, hematoma, nausea or vomiting, with “adverse event” encompassing any instance of the previously mentioned complications. Major 90-day medical complications included pulmonary embolism (PE), pneumonia (PNA), myocardial infarction (MI), cerebrovascular accident (CVA) and sepsis. Minor 90-day complications encompassed deep vein thrombosis (DVT), acute kidney injury (AKI), urinary tract infection (UTI), transfusion and wound complications. Ninety-day surgical site infection and 1-year reoperation rates were also evaluated. Ninety-day associated costs of surgery were defined according to the following categories: 1) surgeon (payments to operating physician), 2) radiographic imaging, 3) office visit, 4) physical therapy/ rehabilitation, 5) emergency department visit, 6) readmission costs, and 7) drugs (including opioids, tramadol and muscle relaxants). Cost refers to payments by the insurance company to service providers. Methods A retrospective review of a national database from the years 2010 to 2018 was performed. The study population included all patients Results Patients undergoing outpatient procedure had decreased rates of major and minor medical complications following both single (major OR 0.60 and multilevel ALIF. Additionally, age >60, female gender, CCI > 3, COPD, diabetes mellitus, coronary artery disease, hypertension and tobacco use were all identified as independent risk factors for increased complications. The cost of outpatient ALIF was $12,013 while the cost of inpatient ALIF was $27,271 (p Conclusions Outpatient ALIF optimizes health care associated costs while providing a safe alternative to traditional inpatient ALIF. The findings add to the growing body of literature advocating for the utilization of ALIF in the outpatient setting for a properly selected group of patients. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.