The following is the summary of “Risk Factors for Ambulatory Surgery Conversion to Extended Stay Among Patients Undergoing One-level or Two-level Posterior Lumbar Decompression,” published in the June 2023 issue of Spine by Dodo, et al.
The purpose of this research was to examine the antecedents and consequences of patients’ transitions from ambulatory surgery (AMS) to observation service (OS) (<48 h) or inpatient (>48 h). Since AMS is associated with equal quality of care compared to inpatient surgery, significant cost reduction, and patients’ desire to rehabilitate at home, it is gaining popularity in the United States. However, there are times when individuals with AMS may have to endure lengthy hospitalizations. Longer-than-expected hospital stays are a hassle for everyone involved, including patients, doctors, and insurers.
Between January 1, 2019, and March 16, 2020, 1,096 patients were surveyed with either a single- or double-level lumbar decompression AMS in an in-hospital, outpatient surgical center. Patients were classified as either AMS, OS, or inpatients based on their length of stay. Data on patients’ demographics, medical histories, procedures, and administrative processes were gathered. Patients with AMS were compared to both outpatients and inpatients, as well as OS and inpatients, using simple and multivariate logistic regression models. From the original number of 1,096 patients, 641 (58%) were sent to either outpatient surgery (n=486) or hospitalization (n=155).
An independent risk factor for converting from AMS to OS/inpatient was found to be age (greater than 80 years old), a high American Society of Anesthesiologists Physical Status (ASA) grade, a history of sleep apnea, the use of drains, a high estimated blood loss, a lengthy operation, a delayed operation start time, and a high pain score. Conditions such as an ASA class 3 or higher, coronary artery disease, diabetes mellitus, hypothyroidism, using steroids, drains, a dural tear, or a laminectomy increase the likelihood that an OS patient may be admitted. Significant associations with AMS conversion and several surgical and patient-specific variables were found. It would be helpful for patients and hospitals if the AMS conversion rate could be lowered by addressing controllable surgical factors.
