A Patients' Guide to Outpatient Surgery

Low Costs, High Quality: Are Ambulatory Surgery Centers (ASCs) the Spine Care Solution?

Patients seeking spine care at ambulatory surgery centers (ASCs) should expect lower costs—but not lower quality—compared to an inpatient hospital setting. This was the finding from a 2018 literature review of the available studies on outpatient spine surgery safety.
Outpatient sign.Outpatient surgery centers offer patients a convenient and cost-effective alternative to having their procedure performed in an inpatient hospital unit.“In our review of the literature, we did not encounter any studies that suggested ASCs negatively impact the efficacy of these surgical procedures,” wrote the researchers who conducted the review, which was published in the August 2018 issue of Neurosurgery.1

ASCs, which are also known as outpatient surgery centers, offer patients a convenient and cost-effective alternative to having their procedure performed in an inpatient hospital unit. Some ASCs exclusively perform spinal procedures—these are known as outpatient spine surgery centers.

ASCs' growth in spine has largely been sparked by advancements in minimally invasive technology, which has allowed a wider range of back and neck surgeries to be performed in an outpatient environment. But the convenience is just one of the benefits of having spine surgery at an ASC. As the researchers in the literature review discovered, outpatient spine surgery often comes at a much lower price tag.

The Cost Component: How ASCs Stack Up Against Hospitals

ASCs provide same-day spine surgery, which means little or no overnight stays. That’s just one way the ASC model drives cost savings for patients. For spine surgery alone, the researchers noted that ASCs deliver annual cost savings of $140 million.

“ASCs are known to achieve efficiencies of cost through specialization of care, smaller size, and the ability to rapidly engage in perioperative process improvement,” the researchers wrote.

Below are some of the cost savings noted in the literature review that were attributed to specific outpatient spine surgery procedures:

  • The researchers cited a study that found the cost of outpatient cervical disc replacement surgery was 84% less than its inpatient counterpart.
  • A large review of outpatient lumbar discectomies revealed that outpatient facility charges were less than 50% of inpatient charges.
  • Costs of anterior cervical discectomy and fusion (ACDF) performed at an ASC have reportedly been less than 50% that of inpatient ACDF charges.

Low Cost, Low Spine Surgery Quality? Not So, Says the Research

When it comes to value, cost is only half the story—quality must also be preserved. To assess the quality of spine care at ASCs, the literature review focused on the outcomes for patients who had the following lumbar (low back) and cervical (neck) surgeries in ASCs:

Key finding: The authors cited a study following more than 4,700 outpatient ACDF patients that found only 1.5% of those patients had complications, while 3.9% of patients who had an inpatient ACDF had complications.

Key findings: A study following 424 patients who had an outpatient posterior cervical foraminotomy reported a low 2.2% complication rate, with more than 98% having symptom improvement.

Key findings: A study on outpatient cervical disc replacement outcomes found no reported perioperative complications or post-operative emergency room (ER) visits/hospitalizations in the patient sample. Plus, all patients’ symptoms improved.

Key findings: “Numerous studies have now shown the complication rates, hospital transfer rates, and readmission rates for outpatient lumbar decompression surgeries are equivalent if not superior to that of inpatient procedures,” the authors wrote.

Key findings: The authors highlighted a study that compared patients who had either inpatient or outpatient 1- and 2-level MIS-TLIF. Patients in both groups had similar:

  • Levels of pain improvement
  • Perioperative readmission rates (3.1% outpatient, 4.7% inpatient)
  • Need for a second surgery (9.4% outpatient, 14% inpatient)

Key finding: The authors noted a study that found patients undergoing LLIF in an ASC reported similar back pain improvement scores to patients who had the surgery in an inpatient hospital setting.

Overall, the researchers concluded that the ASC environment affords patients an economical and safe surgical site.

“The most fundamental component of quality, particular in the surgical realm, is safety,” the authors wrote. “The crucial question before us, then, is whether ambulatory spine surgery is as safe as in the inpatient hospital setting. With certain caveats, the answer appears to be yes.”

Should You Pursue Spine Care at an ASC?

Despite the rapid growth of ASCs, some patients aren’t ideal candidates for outpatient spine surgery. If you have a heart condition or other chronic illness, your doctor may recommend that your surgery be performed in an inpatient unit. Also, more complex spine surgeries (eg, a multi-level fusion for severe spinal deformity) will likely need to be done in a hospital.

If you’re a candidate for spine surgery, ask your doctor about whether having your procedure in an ambulatory surgery center (ASC) is right for you. While this literature review shares encouraging evidence that supports the quality of spine care at ASCs, spinal surgery bears risks no matter where it’s performed. Always talk to your doctor about the benefits and potential complications before you undergo your procedure.

Updated on: 08/30/18
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