Emergency Department Visits After Outpatient Spine Surgery

Study Design. A retrospective study. Objective. This study sought to characterize the incidence and timing of postoperative emergency department (ED) visits after common outpatient spinal surgeries performed at ambulatory surgery centers (ASCs) and at hospital outpatient departments (HOPDs). Summary of Background Data. Outpatient spine surgery has markedly grown in popularity over the past decade. The incidence of ED visits after outpatient spine surgery is not well established. Methods. This study was a retrospective analysis of a large commercial claims insurance database of patients 65 years old and below. Patients who underwent single-level anterior cervical discectomy and fusion, laminectomy, and microdiscectomy were identified. Incidence, timing, and diagnoses associated with ED visits within the postoperative global period (90 d) after surgery were assessed. Results. In total, 202,202 patients received outpatient spine surgery (19.1% in ASC vs. 80.9% in HOPD). Collectively, there were 22,198 ED visits during the 90-day postoperative period. Approximately 9.0% of patients had at least 1 ED visit, and the incidence varied by procedure. anterior cervical discectomy and fusion 9.9%, laminectomy 9.5%, and microdiscectomy 8.5% (P<0.0001). After adjusting for age, sex, and comorbidity index, the odds of at least 1 ED visit were higher among patients who received surgery at HOPD versus ASC for all 3 procedures. The majority (56.1%) ED visits occurred during the first month postoperatively; 30.8% (n = 6841) occurred within the first week postoperatively, and 10.7% (n = 2370) occurred on the same day as the surgery. Postoperative pain was the most common reason for ED visits. Conclusions. Among commercially insured patients who received outpatient spine surgery, the incidence of ED visits during the 90-day postoperative period was similar to 9%. Our results indicate opportunities for improved postoperative care planning after outpatient spinal surgery.