Q: What percentage of spine surgeries do you or could you perform in an ASC?
Hyun Bae, MD, Director of Education, Cedars-Sinai Spine Center, Los Angeles and Medical Director of Center for Spinal Restoration, Santa Monica: I think probably around 25 percent of spine surgeries could be performed in outpatient surgery centers. As we evolve into more minimally invasive procedures, many of those could be done outpatient. Traditionally, we thought cervical fusions couldn't be done outpatient, but we found they could. The technique hasn't changed very much, but we realized that we could do it as more ASCs popped up and surgeons demanded it. Now we've started progressing to do lumbar fusions that weren't always thought of as being performed in an ASC because instrumentation is involved, but there is no question that you could probably do a one-level lateral stand alone lumbar fusion in an ASC.
As surgeons have become investors in ASCs over the past 10 years, there has been another motivation for them to try to take cases into their own surgery center. However, one factor against surgery centers is the fact that insurance companies are making it more difficult for spine procedures to be performed there. I think the other negative factor is more surgeons are becoming hired by the hospital, so they often don't have a choice where their cases are performed.
Hospitals are becoming more restrictive, and surgeons may have to use surgery centers as more of a procedural outlet. Hospitals are hiring more surgeons, and even though anyone can apply for privileges it is becoming harder to get OR time if you aren't a hospital employee. The other issue is that hospitals are monitoring what procedures can be done; there is no question that they aren't allowing some procedures. Positives for surgery centers include the enhanced efficiency, so surgeons can get cases done faster. Resources are also better utilized in surgery centers.
Ara Deukmedjian, MD, Founder, Deuk Spine Institute, Melbourne, Fla.: I could perform 80 percent of my spine surgeries in an ASC or outpatient setting safely and effectively.
Walter Eckman, MD, Founder, Aurora Spine Center, Tupelu, Miss.: We don't have an ASC available to us. Our state insurance company requires one night admission for anterior cervical procedures. Our lumbar surgery (discectomy, decompressions and fusions) are virtually all managed as same day surgery. We feel 95 percent of our lumbar patients could be done as outpatients.
J. Brian Gill, MD, Spine Surgeon, Nebraska Spine Center, Omaha: I would only feel comfortable doing a few procedures at an ASC, which include lumbar discectomies, single-level lumbar decompression, single-level anterior cervical decompression and fusion, and spinal injections.
Michael Gleiber, MD, Founder, Michael A. Gleiber, MD, PA, Jupiter, Fla.: I could perform 10 to 20 percent of my procedures in an outpatient setting. Many of these procedures I will perform early on my surgery days and discharge the patient from recovery after they ambulate, tolerate oral food, void, and their pain is controlled. There certainly is an opportunity to bring this volume to an outpatient center.
Khawar Siddique, MD, Spine Surgeon, Beverly Hills Spine Surgery, Calif.: Currently 30 percent [performed outpatient], but aiming for 60 percent.
Paul Slosar, MD, President, SpineCare Medical Group, San Francisco Spine Institute: It depends on the case complexity of an individual practice. I currently perform microdiscectomy cases and many of my one and two level anterior cervical cases in an ASC. If 23 hour observation is available, then ASC spine volumes can increase.
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