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  • Cost and disparities in outpatient lumbar discectomies in four US States: and analysis of the State Ambulatory Database (SASD) and the State Inpatient Database (SID)

    Final Number:

    Kimon Bekelis MD; George V. Kakoulides MD; Symeon Missios MD

    Study Design:
    Clinical Trial

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2013 Annual Meeting

    Introduction: Several groups have demonstrated the safety of outpatient lumbar discectomies with no patients experiencing complications related to early discharge. Although they appear to be safe, the reasons factoring into the selection of patients undergoing ambulatory procedures have not been investigated.

    Methods: We performed a retrospective cohort study involving 40,001 patients who underwent outpatient and 139,322 patients who underwent inpatient lumbar discectomies and were registered in State Ambulatory Surgery Databases (SASD) and State Inpatient Databases (SID) respectively for 4 US States (New York, California, Florida, North Carolina) from 2005 to 2008.

    Results: In a multivariate analysis male gender (OR 1,22, 95% CI, 1.19, 1.25), and high volume hospitals (OR 1.11, 95% CI, 1.08, 1.14) were significantly associated with outpatient procedures. Older age (OR 0.99, 95% CI, 0.98, 0.99), non-white patients (OR 0.55, 95% CI, 0.53, 0.57), low income (OR 0.11, 95% CI, 0.10, 0.13), coverage by Medicare/Medicaid (OR 0.57, 95% CI, 0.55, 0.59), and higher Charlson Comorbidity Index (OR 0.23, 95% CI, 0.18, 0.29), were associated with a decreased chance of outpatient procedures. Institutional charges were significantly less for outpatient lumbar discectomies. There was no difference in the rate of 30-day postoperative readmissions among inpatient and outpatient procedures.

    Conclusions: Access to ambulatory lumbar discectomies appears to be affected by several socioeconomic factors. Further investigation is needed in the direction of mapping these disparities in resource utilization.

    Patient Care: It will allow the identification of factors resulting in disparities in healthcare delivery. Those disparities can be addressed by developing appropriate healthcare delivery systems

    Learning Objectives: By the conclusion of this session, participants should be able to: 1) describe the socioeconomic disparities among patients undergoing inpatient and ambulatory lumbar discectomies 2) describe the differences in cost among inpatient and outpatient lumbar discectomies


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