5 Comments on Spine Surgeries in ASCs From Surgeons Who Perform Them

written by Laura Miller | Becker's Orthopedic, Spine, and Pain Management Review | November 21, 2011

Here are five spine surgeons performing cases in ambulatory surgery centers and why they urge other surgeons to transition into the outpatient setting.

1. Richard Hynes, MD, The Back Center (Melbourne, Fla.). Dr. Hynes says the advantages of performing cases in the ASC include the same or quicker recovery time, reduced length of stay in a medical facility and same-day recovery. He performs several procedures, including laminectomies, anterior cervical discectomies and fusions and other minimally invasive, percutaneous spine procedures in an outpatient ambulatory surgery center.

Improved technology for less invasive procedures has made it possible to bring spine cases into the outpatient setting, according to Dr. Hynes. Interbody fixation, bone morphogenic protein and percutaneous procedures are the way of the future, he says, and the methodology will continue to evolve for better outcomes.

2. James Lynch, MD, SpineNavada, Surgery Center of Reno. Dr. Lynch performs spine surgery in an ASC and says it's good business in today's cost- and quality-conscious healthcare environment to do so. Positive data for spine surgery and spine surgeons in the ASC setting will play a large role in the future, as comparative profiling of physicians using data points allows patients to "shop" for physicians and hospitals to benchmark providers against one another, he says.

He expects to see spine technology revolve around minimally invasive spine surgery, robotics, nuclear disc replacement and imaging in the future. An additional shift toward generic spinal implants could help administrators manage costs at ASCs and specialty spine facilities.

3. Robert Nucci, MD, Citrus Park Surgery Center (Tampa, Fla.). Dr. Nucci performs several cases in outpatient ASCs, including far lateral interbody fusions. To perform single or multi-level FLIFs, Dr. Nucci removes the disc through a small incision, inserts a mesh cage and inflates it with allograft bone. The average OR time for the procedure is 129 minutes, surgeon time is 118 minutes and recovery time is 180 minutes. The average blood loss is 141 cc and there is minimal muscle tissue disruption.

Dr. Nucci also performs cervical disc replacement in ASCs using an artificial disc. The average OR time is 92.4 minutes, surgeon time is 77.5 minutes and recovery is 140.8 minutes. Patients are under anesthesia for approximately two hours and experience average blood loss of 95 cc. He hasn't experienced any complications with that procedure. The reasons he cites for performing these cases in an ASC include:

•    The infection rate is lower than in hospitals
•    There is less overhead cost and increased efficiency in the OR
•    Shorter anesthesia time

4. Joan O'Shea, MD, The Spine Institute of Southern New Jersey. Dr. O'Shea predicts at least 80 of practicing spine and neurosurgeons are capable of performing their cases in the ASC, whether they are currently doing so or not. However, not every surgeon is suited for the switch; she notes that ASC surgeons must perform quick surgeries, be confident in their surgical ability and have a good support team.

For her cases in the ASC, Dr. O'Shea increases patient comfort and decreases the risk of complications by:
•    Taking patients off of medications during the preoperative
•    Using cottonoids to stop epidural bleeding
•    Using Decadron to relieve patients of post-operative nausea and vomiting
•    Using cervical traction five to 15 pounds
•    Encouraging early ambulation to avoid urinary issues

5. Ken Pettine, MD, The Spine Institute, Loveland (Colo.) Surgery Center. Spine surgeries performed at the hospital are a significant expense and surgeons stand to leave money on the table if they perform procedures there instead of an ASC, Dr. Pettine says. His experience shows outpatient spine surgery can be performed safely and effectively in ASCs; in the 284 outpatient spine cases Dr. Pettine has performed, he reports no complications (although his ASC has a 23-hour convalescence center). He recommends ASCs start slow with less complicated cases, such as decompressions, and then moving to the more complicated procedures.

To recruit spine surgeons, ASC administrators can present data about the safety and efficacy of spine in other ASCs and entice them through shared income. Insurance contracts for spine can be attractive to payors because implant carve-outs bill 10 percent over retail price while hospitals bill significantly higher. Surgery centers can gain an even higher return if they negotiate discounts with device companies.


Read the original article on Becker's Orthopedic, Spine, and Pain Management Review.

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