Readmission Rate After 2-level Lumbar Decompression: A Propensity-matched Cohort Study Comparing Inpatient and Outpatient Settings.

Autor:	Elsharydah A; Departments of Anesthesiology and Pain Management., Duncan KL; Departments of Anesthesiology and Pain Management., Rosero EB; Departments of Anesthesiology and Pain Management., Minhajuddin A; Clinical Sciences, University of Texas Southwestern Medical Center., Somasundaram A; University of Texas Southwestern Medical School, Dallas, TX., Joshi GP; Departments of Anesthesiology and Pain Management.
Jazyk:	angličtina
Zdroj:	Clinical spine surgery [Clin Spine Surg] 2021 Feb 01; Vol. 34 (1), pp. E1-E6.
DOI:	10.1097/BSD.0000000000000990
Abstrakt:	Study Design: Retrospective review of the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database years 2012-2015. Objective: Compare the 30-day readmission and postoperative major complications rates of 2-level lumbar decompression performed in the ambulatory and the inpatient settings. Summary of Background Data: In recent years, there is an increasing trend toward ambulatory spine surgery. However, there remains a concern regarding risks of readmission and postoperative morbidity after discharge. Methods: The ACS-NSQIP database from 2012 to 2015 was queried for adult patients who underwent elective 2-level lumbar decompression (CPT code 63047 accompanied with code 63048). A cohort of ambulatory lumbar decompression cases was matched 1:1 with an inpatient cohort after controlling for patient demographics, comorbidities, and complexity of the procedure. The primary outcome was the 30-day readmission rate. Secondary outcomes included a composite of 30-day postoperative major complications and hospital length of stay for hospitalized patients. Results: A total of 7505 patients met our study criteria. The ambulatory 2-level lumbar decompression surgery rate increased significantly over the study period from 28% in 2012 to 49% in 2015 (P<0.001). In the matched sample, there was no statistically significant difference in the 30-day readmission rate (odds ratio, 0.82; 95% confidence interval, 0.64-1.04; P=0.097) between the two cohorts; however, the ambulatory cohort had a lower 30-day postoperative major complication rate (odds ratio, 0.55; 95% confidence interval, 0.38-0.79; P=0.002). Conclusions: After 2-level lumbar decompression performed on inpatient versus outpatient basis, the 30-day readmission rate is similar. However, the 30-day postoperative complication rate is significantly lower in the ambulatory setting. The reasons for these differences need further exploration. Level of Evidence: Level III. Competing Interests: The authors declare no conflict of interest. (Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.)
Databáze:	MEDLINE
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