Study: No differences seen in ACDF safety or effectiveness based on surgical setting

Anterior cervical discectomy and fusion done at ambulatory surgery centers rather than inpatient yielded cost savings of $7,000, researchers noted.

Investigators demonstrated in an award-winning study that anterior cervical discectomy and fusion procedures to treat degenerative conditions of the spine that were performed at an ASC were as effective as those performed in the inpatient setting and showed similar complication rates, as well.

Matthew J. McGirt, MD, presented the findings at the Congress of Neurological Surgeons (CNS) Annual Meeting in Boston. The investigation showed that anterior cervical discectomy and fusion procedures (ACDF) performed at an (ASC) can also be less costly when compared with the same procedure performed at an inpatient facility.

Matthew J McGirt

He and his co-investigators received the Samuel Hassenbusch Young Neurosurgeon Award at the CNS Annual Meeting for the research.

Similar ACDF outcomes

“One and two-level [anterior cervical discectomy and fusion] ACDF is a commonly performed surgery that can be safely and effectively performed in the low-cost setting of an ambulatory surgery center for most patients. Transitioning ACDF to the outpatient setting provides an immediate opportunity for more efficient surgical spine care and value-based improvement from the perspective of payer, provider and patient,” McGirt told Spine Surgery Today.

One-hundred twelve consecutive cases of single or double-level ACDF were performed at two centers and patients were prospectively enrolled in a common registry.

McGirt and colleagues included 53 outpatient ACDF procedures and 59 inpatient procedures in the study and they prospectively assessed 90-day morbidity, return to work and patient reported outcomes at 3 months postoperatively. Both groups of patients had similar baseline demographics and the cohorts were fairly well matched except that, as might be expected, coronary artery disease and diabetes were slightly more prevalent in the inpatient cohort.

Similar readmissions, morbidity

According to the results, the 30-day and 90-day readmission rates were not statistically different between the groups, at 0.0% for the outpatient cohort at both time points and 1.7% for the inpatient cohort at both time points.

The researchers found similar 90-day morbidity rates in the two groups.

Figure 1. One- and two-level anterior cervical discectomy and fusion can be safely and effectively performed in the low-cost ASC setting, Matthew J. McGirt, MD, and colleagues found.

Source:McGirt MJ

“If you look at the morbidity between the groups, you see the same thing. We see there is zero difference in complication, readmission or reoperation in the safety profiles of where you do this. There is a slight decrease in length of surgery at an outpatient specialty center, as well,” McGirt said in his presentation at the meeting.

“Now, we are moving beyond a safety comparison and into patient benefit or effectiveness. You can see surgery in both settings is equally effective when you look at return to work, which is very important in a societal perspective,” he said.

McGirt noted the complication rates between the two cohorts were similar. One patient who underwent outpatient surgery developed a complication. Patients in the outpatient group were kept at the ASC for 4 hours postoperatively to see if they developed a complication.

Possible health care waste

According to McGirt, a patient sitting in an inpatient facility for an entire day after a procedure could be considered health care waste. These patients do not seem to have fewer complications, readmissions or reoperations if they are only held for a 4-hour window rather than a 24-hour window, he said.

“Throughout the acute care, post care episode, where the greatest variation in cost exists in surgical care, ASC was associated with a $7,000 cost saving with equivalent quality-adjusted life year gained,” McGirt said at the meeting. “This is a cost saving advancement in ACDF surgery. From a patient, payer, purchaser and societal perspective, the ASC setting offers superior value and can lead to cost savings of over $7,000 per patient,” he said. – by Robert Linnehan

Reference:

McGirt MJ, et al. Paper #139. Presented at: Congress of Neurological Surgeons Annual Meeting; Oct. 18-22, 2014; Boston.

For more information:

Matthew J. McGirt, MD, can be reached at Carolina Neurosurgery & Spine Associates, 225 Baldwin Ave., Charlotte, NC 28204; email: matt.mcgirt@cnsa.com.

Disclosure: McGirt is a consultant for DePuy and Stryker.