Department of Neurosurgery, Stanford University, Stanford, California.
Depart-ment of Medicine, Quantitative Sciences Unit, Stanford University, Stanford, California.
Neurosurgery. 2018 Apr 1;82(4):454-464. doi: 10.1093/neuros/nyx215.
Outpatient anterior cervical discectomy and fusion (ACDF) is a promising candidate for US healthcare cost reduction as several studies have demonstrated that overall complications are relatively low and early discharge can preserve high patient satisfaction, low morbidity, and minimal readmission.
To compare clinical outcomes and associated costs between inpatient and ambulatory setting ACDF.
Demographics, comorbidities, emergency department (ED) visits, readmissions, reoperation rates, and 90-d charges were retrospectively analyzed for patients undergoing elective ACDF in California, Florida, and New York from 2009 to 2011 in State Inpatient and Ambulatory Databases.
A total of 3135 ambulatory and 46 996 inpatient ACDFs were performed. Mean Charlson comorbidity index, length of stay, and mortality were 0.2, 0.4 d, and 0% in the ambulatory cohort and 0.4, 1.8 d, and 0.04% for inpatients (P < .0001). Ambulatory patients were younger (48.0 vs 53.1) and more likely to be Caucasian. One hundred sixty-eight ambulatory patients (5.4%) presented to the ED within 30 d (mean 11.3 d), 51 (1.6%) were readmitted, and 5 (0.2%) underwent reoperation. Among inpatient surgeries, 2607 patients (5.5%) presented to the ED within 30 d (mean 9.7 d), 1778 (3.8%) were readmitted (mean 6.3 d), and 200 (0.4%) underwent reoperation. Higher Charlson comorbidity index increased rate of ED visits (ambulatory operating room [OR] 1.285, P < .05; inpatient OR 1.289, P < .0001) and readmission (ambulatory OR 1.746, P < .0001; inpatient OR 1.685, P < .0001). Overall charges were significantly lower for ambulatory ACDFs ($33 362.51 vs $74 667.04; P < .0001).
ACDF can be performed in an ambulatory setting with comparable morbidity and readmission rates, and lower costs, to those performed in an inpatient setting.
门诊颈椎前路椎间盘切除术和融合术（ACDF）是降低美国医疗成本的有前途的选择，因为多项研究表明，总体并发症相对较低，早期出院可以保持高患者满意度、低发病率和最低再入院率。
比较住院和门诊 ACDF 的临床结果和相关成本。
回顾性分析了 2009 年至 2011 年加利福尼亚州、佛罗里达州和纽约州州立住院和门诊数据库中接受择期 ACDF 的患者的人口统计学、合并症、急诊就诊、再入院、再次手术率和 90 天费用。
共进行了 3135 例门诊和 46996 例住院 ACDF。门诊组的平均 Charlson 合并症指数、住院时间和死亡率分别为 0.2、0.4 天和 0%，而住院组分别为 0.4、1.8 天和 0.04%（P<.0001）。门诊患者更年轻（48.0 岁 vs 53.1 岁），更有可能是白人。168 名门诊患者（5.4%）在 30 天内（平均 11.3 天）到急诊就诊，51 名（1.6%）再入院，5 名（0.2%）再次手术。在住院手术中，2607 名患者（5.5%）在 30 天内（平均 9.7 天）到急诊就诊，1778 名（3.8%）再入院（平均 6.3 天），200 名（0.4%）再次手术。Charlson 合并症指数较高会增加急诊就诊率（门诊手术室[OR]1.285，P<.05；住院 OR 1.289，P<.0001）和再入院率（门诊 OR 1.746，P<.0001；住院 OR 1.685，P<.0001）。门诊 ACDF 的总费用明显低于住院 ACDF（33362.51 美元 vs 74667.04 美元；P<.0001）。
ACDF 可以在门诊环境中进行，其发病率和再入院率与住院环境相当，且成本更低。
