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  • Anterior Cervical Diskectomy and Fusion (ACDF) in the Ambulatory Care Setting: Defining its Value Across the Acute and Post-acute Care Episode

    Final Number:

    Matthew J. McGirt MD; Saniya S. Godil MBBS; Tim E. Adamson MD; E. Hunter Dyer MD; Silky Chotai MD; Anthony L. Asher MD FACS; Domagoj Coric MD

    Study Design:

    Subject Category:

    Meeting: Section on Disorders of the Spine and Peripheral Nerves Spine Summit- 2017

    Introduction: In the era of current healthcare reforms, all stakeholders have adopted value-based purchasing strategies to shift care toward higher benefit and lower cost treatment approaches. Degenerative spine disease is highly prevalent and its surgical intervention costly. In this study, we set out to quantify the potential cost savings and patient-centered benefits associated with performing ACDF in an ambulatory surgery center versus inpatient hospital setting.

    Methods: 112 consecutive cases of one or two-level anterior cervical diskectomy and fusion(ACDF) performed at two centers were prospectively enrolled into a common registry. Data was collected on patient demographics, operative details and peri-operative and 90-day morbidity. 90-day morbidity, return to work, and 3-month patient reported outcomes were prospectively assessed. Direct costs were estimated from resource utilization via macro-costing with private pay estimated as 1.7 x Medicare fee schedule. Indirect costs were calculated from lost work productivity using standard human capital approach.

    Results: 53 outpatient ACDF and 59 inpatient ACDF patients were included. Cohorts were similar at baseline. 90-day surgical morbidity was similar between outpatient vs inpatient cohorts: 30-day readmission (0.0% vs. 1.7%;p=0.34), 90-day readmission (0.0% vs. 1.7%;p=0.34), DVT (0.0% vs. 1.7%;p=0.34), dysphagia requiring NPO/NG tube (0.0% vs. 1.7%;p=0.34) and neck hematoma (0.0% vs. 1.7%;p=0.34),Table 1. Improvement in three-month pain, disability, QOL, and return to work were also similar between two cohorts, Figures 1 & 2. Mean total 3-month cost per patient was significantly reduced in the outpatient vs. inpatient surgery cohort ($20,043 vs. $27,123;p<0.001) with similar QALY-gained,Table 2.

    Conclusions: During the acute care and post-acute care episode, the outpatient ambulatory care versus inpatient hospital setting was associated with significant cost savings without a compromise in safety or clinical effectiveness for ACDF. From a patient, payer, purchaser, and societal perspective, the ambulatory surgery center setting offers superior value and can lead to cost savings of over $7,000 per patient.

    Patient Care: From a patient, payer, purchaser, and societal perspective, the ambulatory surgery center setting offers superior value and can lead to cost savings and overall improve value of spine care.

    Learning Objectives: In an era of escalating health care costs and pressure to improve efficiency and cost of care, ambulatory surgery centers have emerged as lower-cost options for many surgical therapies.


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