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Trends in Inpatient versus Outpatient Lumbar Microdiscectomy in the United States of America: An Epidemiologic and Economic Analysis



Objective: Lumbar discopathy is the most common cause for lower back-pain with the exception of non-specific lower back-pain. Lumbar microdiscectomy is the number one neurological surgery procedure performed in the country and is the first major spine surgery to transition to the ambulatory setting. Analysis on a national level is important to understand the transition in healthcare. The authors aim to report on the incidence of lumbar microdiscectomy in the United States of America (USA) using a national database over a seven-year period and the associated procedural reimbursement costs.

Methods: A query was performed for patients who underwent lumbar microdiscectomy using the Pearldiver Supercomputer (Warsaw, IN) from 2007 to 2014. Patients were identified by current procedural terminology (CPT) codes 63020, 63030 and 63035 and their demographics, location of surgery and reimbursement costs were later analysed.

Results: The query returned a total of 38 636 lumbar microdiscectomies over the seven-year study period of 2007 to 2014. The total number of procedures performed as outpatients increased significantly from 906  in 2007 to 2647 in 2014 (p = 0.015); whereas those performed as inpatients had a smaller increase from 2437 in 2007  to 2788 in 2014 (p = 0.888). Of the total amount of surgeries, 20 884 (60.1%) were performed in the inpatient setting compared to 12 765 (39.9%) performed in outpatient setting, (p< 0.001). The seven-year mean reimbursement cost for lumbar microdiscectomy done in the inpatient setting was $809.75 compared to $4181.88 in the outpatient setting, which was statistical significant (p = 0.027). Correlation analysis demonstrated that the increase in the incidence of outpatient lumbar microdiscectomy being performed had a high correlation (R = 0.914) to reimbursements, with a significance of p = 0.002.

Conclusion: There has been a significant increase in lumbar microdiscectomy over past seven years being performed as outpatient procedures. Mean reimbursement was shown to be a significant correlating factor for this increase. 

12 May, 2017
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e-Published: 10 Jul, 2017
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