Comparing Complications and Costs of Anterior Cervical Discectomy and Fusion in the Inpatient, Outpatient, and ASC Settings in the Medicare Population

Retrospective cohort study. The aim of this study was to compare differences in postoperative readmission rates, complications, and costs for one- to two-level ACDFs among Medicare fee-for-service beneficiaries performed in an inpatient, hospital outpatient, or ASC. Anterior cervical discectomy and fusion (ACDF) is increasingly performed in the outpatient setting. There is a paucity of literature examining the safety and differences in cost of performing these procedures in the outpatient setting. Patients who underwent a primary one- or two-level ACDF from 2016 to 2021 were retrospectively identified using Current Procedural Terminology (CPT) codes. A total of 118,692 patients were included in the analysis. Demographic data, surgical characteristics, postoperative readmissions and complications, as well as cost data, were collected through the Centers for Medicare and Medicaid Services. Patients were matched by demographic, comorbidity, and surgical characteristics, and univariate analysis was performed to determine differences in outcomes by surgical setting. The proportion of Medicare patients undergoing ACDF at a hospital outpatient or ASC steadily increased from 2016 to 2021, ultimately as high as 49.2% in 2021. Total adjusted initial ("index") surgery (ASC $9898 vs. OP $13,011 vs. IP $33,911) and total 90-day episode of care costs (ASC $13,465 vs. OP $17,264 vs. IP $44,016) were significantly lower in both the ASC and outpatient cohorts compared with the inpatient cohort ( P <0.001). ACDFs performed in the ASC or outpatient setting had significantly lower rates of adjusted readmission, total complications, infection, VTE, and revision surgery ( P <0.001) compared with those in the inpatient setting. One- and two-level ACDF is increasingly being performed in an outpatient setting. Outpatient surgery is associated with lower rates of readmission, complications, and costs. By using the Medicare database and matching patients by demographic data and comorbidities, the results support that performing ACDFs at an ASC is safe. Level III.