Randolph Bishop, MD, Neurological Institute of Savannah (Ga.) discusses outpatient spine surgery trends.
Question: How has technology—including the Zeus-O OLLIF--and technique development made it possible to bring spine procedures into the outpatient setting?
Dr. Randolph Bishop: Improved surgical techniques, especially in the form of minimally invasive approaches, has allowed for most elective spinal surgeries to be routinely accomplished in an outpatient setting. The novel and unique implants and surgical technique utilized in the Oblique Lumbar Interbody Fusion require little if any muscle dissection or bone removal which has greatly reduced post op pain, intra-operative blood loss, and duration of surgery. All of which contributed to the need for an inpatient setting in the past.
Q: What advantages are there for surgeons and patients to performing the spinal cases as outpatient procedures?
RB: The advantages of using an outpatient center for the performance of spine surgery yields similar advantages to what has been demonstrated in other subspecialties. An outpatient surgery center provides for a more personal level of patient care which is a strong positive for both patients and surgeons. The care delivered is much more specialized and the center can be more focused on a specific specialty which leads to a more efficient and effective delivery of service.
Q: What is the economic impact of being able to perform spinal surgeries in the outpatient setting?
RB: There is no doubt that performing spinal surgery in an outpatient setting provides marked reduction in cost of care. Not only is the actual surgery less expensive secondary to better efficiency, there are no additional costs that may come about with hospitalization such as nosocomial infections and medication errors.
Q: Where do you see the most opportunity for outpatient spine surgery to grow and develop in the future?
RB: Specialty outpatient spine surgery centers will be the location where novel and unique treatments for spinal disease will originate and develop. The development of adult stem cells to delay or slow the degenerative cascade will be a technology that will come from these centers. The bureaucracy of hospitals and larger institutions will prove to be a hurdle in pioneering this and other new treatments.
Q: What is the best piece of advice you have for spine surgeons just beginning to consider performing cases in the outpatient setting?
RB: The performance of most routine spinal surgeries will be performed in an outpatient setting in the future. Surgeons that do not prepare for this will be unable to compete effectively against those that do and these same surgeons may in fact be viewed as "less capable" as a result.
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