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


As described earlier, the difference between outpatient surgery performed at a hospital and that performed at an ambulatory center confounds direct comparison of the cost savings. However, in single-center studies, several authors have reported their own cost savings. For example, performing lumbar laminectomy in an ambulatory surgery center can produce a 30% facility fee reduction.[29] Similarly, Silvers et al. reported a cost savings of $1800 per ACDF performed in 1996 and estimated a cost savings of $140 million nationwide for that same year if every 1- or 2-level ACDF were performed in the outpatient setting.[38] Wohns found the cost of a single-level outpatient cervical disc arthroplasty to be 62% less than an outpatient ACDF and 84% less than an inpatient cervical disc arthroplasty.[46] This suggests that cost is a complex result of procedure, instrumentation, facility fee, and length of stay.[30] Purger et al. modeled costs and charges including all complications, readmissions, and reoperations within 90 days as a bundled charge and found significant savings in the outpatient ACDF cohort—nearly half the total for inpatient ACDF.[35] The 90-day bundled charge represents one of the proposed Medicare value-based reimbursement paradigms and is an ideal metric for future cost studies.