Eligibility of Outpatient Spine Surgery Candidates in a Single Private Practice

Level III. To retrospectively review the eligibility of surgical patients meeting predetermined outpatient surgery criteria in a single-surgeon private practice. There is a burgeoning awareness among patients, surgeons, and insurers of the cost benefits and safety of outpatient spine surgeries. At the end of 2014, Centers for Medicare & Medicaid Services have released its final 2015 payment rules and codes for spinal decompression and fusion. This move confirms the safety of procedures being performed in the ambulatory surgery centers (ASCs). We conducted a database review between 2008 and 2014 and identified 1625 orthopedic procedures. All nonsurgical spine procedures were excluded from the study. Eligibility for outpatient spine surgery was based on criteria generated from a combination of published standard of care for major operations and the chief surgeon's experience. A matched cohort based on type of surgery in each facility of all spine surgery patients was created, group 1 (hospital patients) and group 2 (ASC patients). A total of 708 patients underwent spinal surgery during this time period with a 53% female population. A total of 557 of 708 (79%) patients were eligible for outpatient spine surgery. There were 210 surgical procedures in group 1 (inpatient) comprised of 72 decompression and 138 fusion procedures. In group 2 (outpatient), there were 347 procedures made up of 150 patients undergoing decompression and 197 undergoing fusion or disc replacement. To confirm that hospital procedures are eligible to be performed in the ASC, the χ test was performed. We found that ASC-eligible hospital patients can indeed be done in an ASC (P=0.037). Outpatient spine surgery is feasible in 79% of patients in this single-surgeon private practice. On the basis of these results, a majority of spine procedures can be performed in an outpatient setting following our eligibility criteria.