Are ambulatory surgery centers a safe and effective setting for spinal cord stimulator placement?

OBJECTIVE: Spinal cord stimulation (SCS) is an effective treatment for refractory chronic back and leg pain. The aim of this study was to compare the safety and efficacy of thoracic paddle lead placement for SCS in the ambulatory surgery center (ASC) setting versus the hospital setting. METHODS: This is a single-institution retrospective cohort study that included adult patients who underwent thoracic paddle lead placement for SCS from September 2021 to December 2024. Patients were included if they had baseline and 3-month patient-reported outcome measures (PROMs). PROMs included back pain and leg pain (numeric rating scale), quality of life (EQ-5D), and patient satisfaction (North American Spine Society questionnaire). Patients were grouped according to whether they underwent surgery in an ASC or hospital setting. A propensity score-matching analysis was performed to control for confounding variables. RESULTS: There were 222 patients (130 female, mean age 65.2 years) in the ASC group and 147 patients (87 female, mean age 65.9 years) in the hospital group. Patients who underwent surgery in the hospital setting had a higher BMI, lower levels of education, and more comorbidities. Although patients who underwent surgery in the ASC setting were less likely to be readmitted within 90 days, this finding did not remain after propensity score matching. Patients in the ASC group had a shorter mean operative duration and length of stay. There were no significant differences between the groups regarding returns to operating room, 3-month postoperative outcomes, or patient satisfaction with surgery. CONCLUSIONS: In appropriately selected patients, SCS with thoracic paddle lead placement appears to be a safe and effective procedure to perform in an ASC setting and compares favorably with similar procedures performed in a hospital setting.