More surgeons are able to bring their cases to the outpatient setting today with new technology and surgical techniques.
"[There are] better, less disruptive retractor systems that allow surgery to be performed in a more efficient and less morbid way," says Todd Alamin, MD, an orthopedic spine surgeon at Stanford Medicine in Redwood City, Calif. The new technology includes ex-tubular retractor systems and other smaller retractor systems. "Better operative microscopes allow for surgical goals to be accomplished through less disruptive exposures, better lighting, visualization and magnification."
The surgical approaches include unilateral approaches for bilateral lumbar decompressions which are technically more demanding, but allow for thorough decompression without disrupting muscle groups on both sides of the spine.
Here are five key ways to optimize outpatient spine surgery cases:
1. Educate the patient on outpatient surgery. Have a conversation with the patient about the outpatient setting so they expect to return home the same day, or in less than 24 hours after surgery. Create the right expectations so the patients know some pain is normal and have a plan in place if there are complications after returning home.
"Patient education and patient selection is the most important aspect of optimizing outpatient procedures," says Neil Badlani, MD, a spine surgeon with North American Spine in Houston. "Patients should be willing and motivated to have an outpatient procedure and interested in a quicker recovery."
2. Plan for potential issues. Collect the patient's emergency numbers and plan for hospital transfers if necessary. "Sometimes the outpatient plan doesn't work," says Dr. Alamin. "You need a plan in place to deal with that upfront so that 'bounce backs' don't happen. That's a big patient dissatisfier and a quality control problem."
3. Understand local anesthetic. The local anesthetic is a gentle technique which includes early anesthetic infiltration. "This decreases morbidity of anesthetic for older patients and allows surgery to be more predictably performed in the outpatient setting," says Dr. Alamin. "Newer longer acting local anesthetics promise better pain control for the early postoperative period."
4. Early postoperative pain control. The use of long-acting local anesthetic/multimodal pain management can optimize the procedure, including lipospheres encapsulated bupivacaine.
5. Consider patient risks. One of the most frequent issues for spine surgery patients, especially in older men, is postoperative urinary retention. "You should have a plan for minimizing this, potentially with input from the patient's urologist," says Dr. Alamin.