Ashish Sahai, MD, a spine surgeon at Spine & Orthopedic Center in Deerfield Beach, Fla., discusses performing minimally invasive spine surgery in the outpatient setting and where he sees this trend headed in the future.
Q: How has technology and technique development made it possible to bring spine procedures into the outpatient setting?
Dr. Ashish Sahai: I think with the advancement of minimally invasive spine surgery with less blood loss and less tissue disruption there is less pain postoperatively. The decompression surgeries are done though a smaller window and fusions are done with less dissection. As a result, the cervical surgeries, done through the native plane, allow us safer and easier access to the surgical site.
Q: What are the advantages for patients to performing the spinal cases as outpatient procedures?
AS: I think patients fear going into the hospital, so they like having their cases done at ASCs. Hospitals are very complicated and intimidating places, and surgery centers are less so. I think the ASC setting decreases patient and family member anxiety.
The second advantage for patients in the ASC setting is fewer intraoperative infections than in the hospitals. There are also risks for patients who have hospital inpatient stays.
Finally, the third advantage is the outpatient setting is financially less expensive, and the patient responsibility is a lot less if you perform their procedures on an outpatient basis.
Q: What is the economic impact of being able to perform spinal surgeries in the outpatient setting?
AS: It goes back to less utilization of resources in the outpatient setting. There are major advantages economically and with less utilization the insurance and patient costs are down as well.
Q: Where do you see the most opportunity for growth in the outpatient spine surgery center setting in the future?
AS: I think endoscopic spine surgery is starting to become an interesting avenue that we are re-evaluating. Simple decompressions and microdiscectomies are moving to the outpatient departments at hospitals, so the ASC setting is the next logical choice. I know one-level ACDF procedures are being performed on an outpatient basis as well.
I think the biggest opportunity is in simple lumbar fusions. They are promising because if you look at the previous progression of procedures into the outpatient setting, they make the most sense. Additionally, there is increased financial pressure on spine procedures and that natural pathway leads to the ASC.
Q: What is the best piece of advice you have for spine surgeons just beginning to consider performing cases in the outpatient setting?
AS: I would say that initially start in the hospital and try to do minimally invasive surgery in that environment where you feel comfortable so you can convert to open surgery if there are issues. When you become familiar working with the minimally invasive techniques, slowly start doing them on an outpatient basis.
Q: What differences are there for surgeons when they first start doing cases at the ASC as opposed to the hospital?
AS: Surgery centers are a little bit different, depending on how they are run. You have fewer resources, so you want to make sure you only use what you need for your surgery. You also want to make sure there is adequate follow-up with the patient so they are monitored postoperatively. When you are in the ASC, make sure you are comfortable with the equipment and instrumentation they have.
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