Over the past two decades, innovation in spine surgery tools and instrumentation has led to a vast and ever-growing selection of artificial discs, expandable cages and pedicle screws, among other devices.
Recent studies have found outpatient spine procedures to be just as safe as — if not safer than — inpatient procedures. With the advancement of minimally invasive surgery, spine surgeons are performing a broader spectrum of procedures more safely and effectively in the outpatient setting.
Here are nine quick details on outpatient spine surgery:
1. There are more than 160 ASCs that perform minimally invasive spine surgery in the U.S.
2. Between 1994 and 2006, outpatient spine surgery increased five-fold, primarily due to perceived cost savings and a surge in the number of ambulatory surgery centers in the U.S.
3. On Jan. 1, 2020, CMS removed six spinal procedures from the inpatient-only list, which means that Medicare now reimburses for the procedures in both the hospital outpatient and inpatient settings. Spine specialist Robert Brady, MD, of Norwalk (Conn.) Hospital will further push the transition of hospital-based surgeries toward outpatient surgical centers.
4. Limited emergency services are a key factor for outpatient spine surgery, causing spine surgeons to thoroughly evaluate patients before opting for surgery. However, this varies from surgeon to surgeon and there are no universally accepted selection criteria for outpatient spine surgery. Ultimately, patients need to be healthy enough to undergo surgery, handle potential complications and motivated enough to be discharged safely on the same day or after a 23-hour stay.
5. Proper patient selection is paramount for outpatient spine surgery. Some factors that may exclude patients are:
- Complex spinal pathology
- Patients over the age of 65
- History of opioid abuse
- Estimated operating time of over 2 hours
- Comorbidities
- History of congestive heart failure
- Increased risk of postoperative nausea and vomiting
- Patients without a reliable caregiver
6. A growing number of spine surgeons are transitioning to more outpatient-focused practices. Frank Phillips, MD, and Kern Singh, MD, of Midwest Orthopaedics at Rush in Chicago recently spoke to Becker's Spine Review about how they are reinventing their practices to achieve a better work-life balance.
7. The average total cost for Medicare patients undergoing anterior cervical discectomy in an ASC is $7,668, compared to $10,713 in a hospital outpatient setting. Total disc replacement on average cost $11,340 in ASCs cost and $15,402 for Medicare patients in hospital outpatient departments.
8. Following the trend of total joint replacement, spine surgeons are opting to perform more outpatient spine surgeries, as the cost of care can be lowered through ASCs versus traditional hospitals. However, this reinforces the need to improve minimally invasive techniques to perform successful outpatient procedures. With such innovations as well as appropriate pain management and patient selection, Richard Chua, MD, of Northwest NeuroSpecialists in Tucson, Ariz., aims to perform 25 percent of his single level lumbar fusions in the outpatient setting.
9. Realizing the need to reduce postoperative pain, spine surgeons are adopting the Enhanced Recovery After Surgery movement to help patients recover safely and effectively after outpatient procedures, according to a study in the Journal of Spine Surgery. The ERAS patient care philosophy focuses on multimodal pain management and is becoming increasingly relevant due to the increased regulation of opioids.