Introduction: Unplanned readmissions have increasingly drawn attention as drivers of cost, adding more than $17 billion to Medicare expenditures. Furthermore, since the passage of the Hospital Readmissions Reduction Program in 2012, hospitals can be heavily penalized for increased 30-day readmissions. In lumbar decompressive surgery, the impact of minimally invasive (MIS) lateral access approaches versus open posterior approaches on readmission rates remains poorly understood. The aim of this study is to determine if MIS lateral access approaches impact 30-day hospital readmission rates compared to open posterior approaches.
Methods: The medical records of 1484 patients who underwent single-stage elective lumbar spinal surgery at multiple institutions were reviewed. Patient demographics, comorbidities, peri-operative variables, complication rates, and readmission rates were collected. The primary outcome investigated in this study was 30-day readmission rate, compared between approaches through univariate analysis.
Results: There were 1242 patients who underwent MIS lateral access surgery and 242 patients who underwent open posterior surgery. Baseline patient demographics and operative course were similar between the two cohorts. While the rate of 30 day readmissions did not significantly vary, there were significantly fewer complications with lateral approaches (13% vs 19%, p=0.02). Furthermore, the rate of reoperation was significantly decreased in the lateral approach (2% vs 5%, p<0.01).
Conclusions: Minimally invasive lateral access surgery, compared to traditional open posterior approach, was associated with a significantly lower rate of post-operative complications. Additionally, lateral access surgeries led to significantly fewer reoperations, thereby reducing risk to the patient and cost to the hospital.
Patient Care: By identifying variances in lateral versus posterior approach outcomes, the appropriate approach can be chosen for to maximize benefit to the patient.
Learning Objectives: By the conclusion of this session, participants should be able to:
1) Identify the benefits of lateral access surgery with regard to readmissions and reoperations