Five spine surgeons weigh in on best practices for providing outpatient spine care.
Ask Spine Surgeons is a weekly series of questions posed to spine surgeons around the country about clinical, business and policy issues affecting spine care. We invite all spine surgeon and specialist responses.
Next week's question: What will change in the healthcare industry in the next 5 to 10 years?
Please send responses to Anuja Vaidya at avaidya@beckershealthcare.com by Wednesday, April 11 at 5 p.m. CST.
Question: What is your advice for spine surgeons looking to enter the outpatient care arena?
Vladimir Sinkov, MD. Spine Surgeon at New Hampshire Orthopaedic Center (Nashua): Outpatient spine surgery has been shown to be safe, effective and very cost-efficient when done on properly selected patients. When deciding whether to take a patient to an ASC, the surgeon must first assess all the medical risks involved with that particular patient — not all patients can go home the day of the surgery due to their medical comorbidities.
The ASC needs to be equipped with all the proper equipment and instruments to perform the surgery as well as to handle common intraoperative complications, such as a dural tears, hardware failure or significant bleeding. The surgeon needs to take time to educate the staff and the anesthesia providers about the spine procedures and proper workflow ahead of time and to review these procedures with them on a regular basis.
Payam Farjoodi, MD. Orthopedic Spine Surgeon at Spine Health Center at MemorialCare Orange Coast Medical Center (Fountain Valley, Calif.): I think it's always best to start doing these types of cases as outpatient surgeries at the hospital until you are comfortable with managing common complications, should they occur. For example, having a plan for treating a nasty dural tear during a microdiscectomy at the surgery center will calm your anxiety should one happen. As you get more comfortable in that setting, and more importantly, the center gets more comfortable with your preferences and needs, it will be easier to increase your volume.
Medhat Mikhael, MD. Pain Management Specialist and Medical Director of the Non-operative Program at the Spine Health Center at MemorialCare Orange Coast Medical Center (Fountain Valley, Calif.): Adopt the concept of minimally invasive spine surgeries that can fix the issue without major changes in the spine anatomy to minimize complications and achieve positive outcomes. This will require accurate diagnosis of the source responsible for generating the pain, and you need to listen carefully to the patient's history, examine thoroughly and avoid operating based on positive findings on MRIs or other imaging studies.
Alden Milam, MD. Spine Surgeon at OrthoCarolina (Charlotte, N.C.): Start with procedures you do well and have reliable results.
Brian R. Gantwerker, MD. Founder of the Craniospinal Center of Los Angeles: I have three pieces of advice. First, pick a center in a nice part of town that patients would want to go. Second, if you can't stand the physical plant, chances are your patients cannot either. And third, beware of promises. Be ready to bring your own cases as no one is going to make hay for you.