• Yusuke Dodo, Ichiro Okano, Neil A Kelly, Leonardo A Sanchez, Henryk Haffer, Maximilian Muellner, Erika Chiapparelli, Lisa Oezel, Jennifer Shue, Darren R Lebl, Frank P Cammisa, Federico P Girardi, Alexander P Hughes, Gbolabo Sokunbi, and Andrew A Sama.
• Spine Care Institute, Hospital for Special Surgery, New York, NY.
• Spine. 2023 Jun 1; 48 (11): 748757748-757.

Study DesignA retrospective observational study.ObjectiveThe objective of this study was to investigate the factors associated with the conversion of patient status from ambulatory surgery (AMS) to observation service (OS) (<48 h) or inpatient (>48 h).Summary Of Background DataAMS is becoming increasingly common in the United States because it is associated with a similar quality of care compared with inpatient surgery, significant costs reduction, and patients' desire to recuperate at home. However, there are instances when AMS patients may be subjected to extended hospital stays. Unanticipated extension of hospitalization stays can be a great burden not only to patients but to medical providers and insurance companies alike.Materials And MethodsData from 1096 patients who underwent one-level or two-level lumbar decompression AMS at an in-hospital, outpatient surgical facility between January 1, 2019, and March 16, 2020, were collected. Patients were categorized into three groups based on length of stay: (1) AMS, (2) OS, or (3) inpatient. Demographics, comorbidities, surgical information, and administrative information were collected. Simple and multivariable logistic regression analyses were conducted comparing AMS patients and OS/inpatient as well as OS and inpatients.ResultsOf the 1096 patients, 641 (58%) patients were converted to either OS (n=486) or inpatient (n=155). The multivariable analysis demonstrated that age (more than 80 yr old), high American Society of Anesthesiologists Physical Status (ASA) grade, history of sleep apnea, drain use, high estimated blood loss, long operation, late operation start time, and a high pain score were considered independent risk factors for AMS conversion to OS/inpatient. The risk factors for OS conversion to inpatient were an ASA class 3 or higher, coronary artery disease, diabetes mellitus, hypothyroidism, steroid use, drain use, dural tear, and laminectomy.ConclusionsSeveral surgical factors along with patient-specific factors were significantly associated with AMS conversion. Addressing modifiable surgical factors might reduce the AMS conversion rate and be beneficial to patients and facilities.Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.

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