Here five spine surgeons weigh in with their thoughts on the movement of spine surgery into the outpatient setting and whether this is a positive trend.
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 are some strategies that you will implement to deal with declining reimbursements?
Please send responses to Anuja Vaidya at avaidya@beckershealthcare.com by Wednesday, Feb. 26, at 5 p.m. CST.
Question: Will spine surgery be performed increasingly in the outpatient setting? If so, do you see this as a positive trend?
Neel Anand, MD, Clinical Professor of Surgery, Director, Spine Trauma, Cedars-Sinai Spine Center, Los Angeles: A lot of spine surgery can be moved to the outpatient setting but only if it is done safely and if the patient is selected appropriately. Technology is good enough that certain procedures an move to the outpatient setting.
But there is only a finite amount of surgery that can be done in the outpatient setting. Patient selection for surgery is what is going to dictate where the surgery is performed. It boils down to how much of a fit the patient is for the spine procedure in the outpatient setting.
Alpesh Patel, MD, Associate Professor in Orthopedic Surgery, Northwestern University Feinberg School of Medicine, Chicago: Absolutely. Not all cases and not all patients will be candidates for outpatient surgery. The combination of minimally invasive techniques, improvements in anesthesia delivery and better postoperative pain protocols will help move more of spine surgery to the outpatient setting. If this is done with a strong eye towards patient safety and cost effectiveness, then it's a very positive trend.
Scott Spann, MD, Founder of Westlake Orthopaedics Spine & Sports and Pantheon Spinal, Austin, Texas: I think that as minimally invasive spine cases increase, outcomes become more predictable and the expected rapid mobilization and immediate postoperative recovery improves, there is no doubt outpatient spine surgery will increase. Patients and family expectations as well as preoperative education will also cause this trend to increase.
I do see this as a positive from the perspective of a more rapid return to a baseline environment. After all, our immune systems are already well adapted to our home environments.
Paul Slosar, MD, President, SpineCare Medical Group, Daly City, Calif.: Yes, on both counts. Many spine surgeons have already moved their microdiscectomy and simple cervical cases to the ASC setting. Centers that offer 23-hour observation for patients will increase their volume of more complex cases as well.
The data is fairly compelling — infection rates are lower and patient satisfaction higher at ASCs, as compared to traditional inpatient hospital settings. Improved minimally invasive techniques combined with better postoperative pain control measures will allow for more spine and total joint cases to shift to the outpatient setting.
Brian R. Gantwerker, MD, Neurosurgeon, The Craniospinal Center of Los Angeles: Most likely more young patients with cash will be seen more in the outpatient setting. This is ultimately a negative trend and I think it will force more of a split in the healthcare system. Less affluent patients will again be forced to wait in long lines at the university centers.
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