Outcomes and Cost-Effectiveness of Hospital Outpatient Versus Ambulatory Surgery Center Lumbar Decompression Surgery

OBJECTIVES: Outpatient spinal surgeries in Ambulatory Surgery Centers (ASCs) have gained traction due to their potential cost efficiencies and improved perioperative processes. This study aims to compare the cost-effectiveness and patient outcomes of lumbar laminectomies performed in hospital settings versus ASCs.

METHODS: A retrospective analysis was conducted on 771 patients who underwent 1 or 2-level outpatient laminectomy between 2019 and 2023. Patient demographics, 90-day and one-year clinical and patient reported outcomes (PROs), and one-year episode of care costs were compared between patients undergoing surgery in the hospital outpatient and ASC settings using univariate analyses. A one-year cost-effectiveness analysis was performed using the EQ-5D to measure quality adjusted life years (QALYs). Cost was evaluated in United States Dollars from the payer perspective. Statistical significance was assessed at p<0.05.

RESULTS: ASC patients demonstrated lower body mass index and American Society of Anesthesiologists (ASA) scores, with a higher prevalence of 1-level laminectomies compared to hospital patients. ASC-based laminectomy was associated with lower initial surgery cost ($4529 ±41 vs. $8060 ±107, p<0.001) and one-year episode of care costs ($5662 ±4748 vs. $10229 ±9202, p<0.001), with similar rates of complications and postoperative resource utilization. One-year improvement in QALYs was similar between settings (Hospital: 0.10 ±0.13 vs. ASC: 0.11 ±0.10, p=0.671). In patients completing baseline and 1-year EQ-5D scores, ASC-based laminectomy was over twice as cost-effective as hospital procedures ($64873/QALY gained vs. $152630).

CONCLUSIONS: The findings support the cost-effectiveness and safety of ASCs for selected patient populations undergoing lumbar laminectomy. ASCs offer substantial cost savings without compromising patient outcomes, making them a viable alternative for appropriately selected patients.