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November 04, 2022
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Several factors linked with conversion from ambulatory surgery to inpatient decompression

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CHICAGO — Results showed several surgical and patient factors were significantly associated with conversion from ambulatory surgery to either outpatient or inpatient surgery in patients undergoing lumbar decompression.

Gbolabo O. Sokunbi, MD, and colleagues categorized patients undergoing one- or two-level lumbar decompression surgery between January 2019 and March 2020 into three groups based on length of stay: ambulatory surgery, observational outpatient surgery (less than 48-hour stay) or inpatient surgery (staying more than 48 hours). Researchers collected demographic data, comorbidities, surgical information and administrative information to compare differences between groups.

Spine surgery
Source: Adobe Stock

“Of the 1,096 patients, 42% were ultimately true [ambulatory surgery] AMS-type patients, 44% were observational or outpatient type surgeries, and 14% were ultimately converted to inpatient status and the most common reason across the board was pain management in these patients,” Sokunbi said.

Gbolabo O. Sokunbi
Gbolabo O. Sokunbi

Sokunbi noted patients who needed more bony or soft tissue work and patients with higher American Society of Anesthesiologists (ASA) classification or a Charlson Comorbidity Index of two or greater had a higher risk of conversion to outpatient or inpatient surgery. In addition, other independent risk factors for conversion from AMS to observational outpatient or inpatient surgery included age greater than 80 years, obstructive sleep apnea, drain use, high estimated blood loss, a higher pain score in the recovery unit and late surgery start time, according to Sokunbi.

He also noted independent risk factors for conversion from observational outpatient to inpatient included ASA classification of three or greater, coronary artery disease, diabetes and hypothyroidism.

“It gets interesting when you start to break things down into patient-related factors vs. surgery-related factors vs. administrative-related factors, and I think you would have to take a deep dive into your institution to figure out where your limitations occur,” Sokunbi said. “For example, when you look at administrative factors, if you start a surgery, at least in my institution, after the time of 12 p.m., it is unlikely that the patient will be leaving within 23 hours. So, these are factors that you would have to apply to your individual institutions, some of which are modifiable, some of which are patient related, and that is what they bring to the table.”