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Comparative Analysis of Inpatient and Outpatient Interspinous Process Device Placement for Lumbar Spinal Stenosis.

Publication ,  Journal Article
Ortega, A; Sarmiento, JM; Patil, C; Mukherjee, D; Ugiliweneza, B; Nuño, M; Lad, S; Boakye, M
Published in: J Neurol Surg A Cent Eur Neurosurg
November 2015

PURPOSE: To compare reoperations, health care utilization, and costs in lumbar spinal stenosis (LSS) patients undergoing interspinous process (ISP) device placement in an inpatient versus outpatient setting. METHODS: The MarketScan database (2007-2009) was queried for adults with LSS undergoing ISP device placement as a primary procedure. Reoperations, health care utilization, and costs in patients with at least 18 months of follow-up were analyzed. Chi-square and Student t tests were used to assess the differences in characteristics and outcomes between patients treated in the inpatient and outpatient setting. RESULTS: A total of 411 patients who underwent ISP device placement were identified; the mean age was 72 years, 51% were female, and most patients were insured by Medicare (73.7%). The average postoperative follow-up was 24.9 months. A subset of 182 patients (44.3%) had inpatient procedures; 229 (55.7%) underwent outpatient ISP device placements. The overall reoperation rate was 20.4%. ISP reoperation rates between inpatient and outpatient cohorts were comparable (23.1% versus 18.3%; p = 0.24). Inpatients accrued significantly higher index procedural costs compared with outpatients ($17,432 versus $8854; p = 0.0001), however, the outpatient cohort utilized more postoperative outpatient services (143 versus 112; p = 0.09) and higher outpatient service costs ($25,376 versus $15,481; p = 0.01). Consequently, cumulative overall cost was similar among the two cohorts ($51,059 versus $51,778; p = 0.94). CONCLUSIONS: Long-term reoperation rates following ISP device placement are comparable in the inpatient and outpatient setting. Upfront cost savings may be achieved with outpatient ISP device placement, but this benefit is lost by 18 months following initial surgery.

Duke Scholars

Published In

J Neurol Surg A Cent Eur Neurosurg

DOI

EISSN

2193-6323

Publication Date

November 2015

Volume

76

Issue

6

Start / End Page

443 / 450

Location

Germany

Related Subject Headings

  • Spinal Stenosis
  • Reoperation
  • Prostheses and Implants
  • Patient Acceptance of Health Care
  • Outpatients
  • Outcome Assessment, Health Care
  • Orthopedic Procedures
  • Middle Aged
  • Male
  • Lumbar Vertebrae
 

Citation

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Ortega, A., Sarmiento, J. M., Patil, C., Mukherjee, D., Ugiliweneza, B., Nuño, M., … Boakye, M. (2015). Comparative Analysis of Inpatient and Outpatient Interspinous Process Device Placement for Lumbar Spinal Stenosis. J Neurol Surg A Cent Eur Neurosurg, 76(6), 443–450. https://doi.org/10.1055/s-0034-1382785
Ortega, Alicia, J Manuel Sarmiento, Chirag Patil, Debraj Mukherjee, Beatrice Ugiliweneza, Miriam Nuño, Shivanand Lad, and Maxwell Boakye. “Comparative Analysis of Inpatient and Outpatient Interspinous Process Device Placement for Lumbar Spinal Stenosis.J Neurol Surg A Cent Eur Neurosurg 76, no. 6 (November 2015): 443–50. https://doi.org/10.1055/s-0034-1382785.
Ortega A, Sarmiento JM, Patil C, Mukherjee D, Ugiliweneza B, Nuño M, et al. Comparative Analysis of Inpatient and Outpatient Interspinous Process Device Placement for Lumbar Spinal Stenosis. J Neurol Surg A Cent Eur Neurosurg. 2015 Nov;76(6):443–50.
Ortega, Alicia, et al. “Comparative Analysis of Inpatient and Outpatient Interspinous Process Device Placement for Lumbar Spinal Stenosis.J Neurol Surg A Cent Eur Neurosurg, vol. 76, no. 6, Nov. 2015, pp. 443–50. Pubmed, doi:10.1055/s-0034-1382785.
Ortega A, Sarmiento JM, Patil C, Mukherjee D, Ugiliweneza B, Nuño M, Lad S, Boakye M. Comparative Analysis of Inpatient and Outpatient Interspinous Process Device Placement for Lumbar Spinal Stenosis. J Neurol Surg A Cent Eur Neurosurg. 2015 Nov;76(6):443–450.
Journal cover image

Published In

J Neurol Surg A Cent Eur Neurosurg

DOI

EISSN

2193-6323

Publication Date

November 2015

Volume

76

Issue

6

Start / End Page

443 / 450

Location

Germany

Related Subject Headings

  • Spinal Stenosis
  • Reoperation
  • Prostheses and Implants
  • Patient Acceptance of Health Care
  • Outpatients
  • Outcome Assessment, Health Care
  • Orthopedic Procedures
  • Middle Aged
  • Male
  • Lumbar Vertebrae