180. Is outpatient anterior lumbar fusion (ALIF) safe? An analysis of 30-day outcomes

BACKGROUND CONTEXT As the current health care system evolves toward implementation of value-based approaches in an attempt to maintain quality-of-care, while reducing overhead costs and unnecessary health care resource utilization, providers and health-policy makers are increasingly looking at transitioning surgeries to outpatient surgery centers and/or facilities. Though outpatient surgery can dramatically reduce costs in an episode of care, their safety and effectiveness with regards to complications and readmission rates still remains a matter of concern. PURPOSE Despite a growing interest toward performing stand-alone ALIFs as an outpatient procedure, no study has evaluated the safety or efficacy of this procedure outside an inpatient setting. STUDY DESIGN/SETTING Retrospective review of prospectively collected data from a national surgical registry. PATIENT SAMPLE The 2012-2017 American College of Surgeons – National Surgical Quality Improvement Program (ACS-NSQIP) was queried using CPT code 22558 to identify patients undergoing a single-level ALIF. Patients receiving concurrent posterior lumbar surgery/fusion/instrumentation, pelvic fixation, or surgery due to tumor, trauma and/or deformity were excluded to capture an isolated cohort of patients receiving single-level stand-alone ALIFs. A total of 3,728 single-level stand-alone ALIFs were included in the study. OUTCOME MEASURES Thirty-day outcomes were subdivided into the following categories, 1) minor adverse events/MAE (superficial SSI, urinary tract infections, bleeding requiring transfusion, pneumonia and progressive renal insufficiency), 2) severe adverse events/SAE (deep SSI, organ/space SSI, wound dehiscence, unplanned intubation, pulmonary embolism, ventilator use >48 hours, acute renal failure, stroke, cardiac arrest, myocardial infarction, deep venous thrombosis, sepsis, septic shock, re-operation and mortality), 3) readmissions and 4) any adverse event/AAE (SAE or MAE). METHODS Multivariate regression analyses were used to compare 30-day adverse events and readmissions while controlling for baseline clinical characteristics. RESULTS Out of a total of 3,728 ALIFs, 149 (4.0%) were performed as outpatient procedure. Following adjustment, outpatient ALIFs vs inpatient ALIFs had a lower odds of experiencing any 30-day adverse event (2.0% vs 9.2%, OR 0.24 [95% CI 0.08-0.76]; p=0.015). No significant differences were noted with regard to severe adverse events (p=0.261), minor adverse events (p=0.995) and readmission rates (p=0.95). CONCLUSIONS Based on the results of the study, it appears that ALIFs may be carried out safely in an outpatient setting in an appropriately selected patient population. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.