Outpatient Spine Surgery: Defining the Outcomes, Value, and Barriers to Implementation

Arjun Vivek Pendharkar, MD; Maryam Nour Shahin, BS; Allen Lin Ho, MD; Eric Scott Sussman, MD; David Arnold Purger, MD, PhD; Anand Veeravagu, MD; John Kevin Ratliff, MD; Atman Mukesh Desai, MD


Neurosurg Focus. 2018;44(5):e11 

In This Article


Within the current body of literature describing outpatient spine surgery, there exists a heterogeneous and ill-defined set of terms that obscures true understanding of the outcomes and cost savings. Fundamentally, any time a patient is discharged from the hospital and has not been admitted to an inpatient ward, they have undergone an outpatient surgery. However, from a reimbursement perspective, there is a clear delineation between a patient whose recovery is observed within a reasonable amount of time before discharge (for example, 4–6 hours in the Medicare Claims Processing Manual, Chapter 4, Section 290.2.2) and a patient who is observed for an extended period of time (< 24 hours). Both of these patient encounters, from an outcomes perspective, can be grouped together as an outpatient procedure but carry different hospital utilization costs.

Similarly, utilization differs between an outpatient procedure performed in association with a hospital and one performed at a freestanding ambulatory surgery center. Idowu et al. examined this difference and found that, although there has indeed been a dramatic increase in the number of hospital-associated outpatient spine operations, there has been a significantly less pronounced increase in spine surgery at freestanding ambulatory centers.[23] In general, the lack of granularity regarding these definitions represents a significant limitation of the literature describing outpatient outcomes.