Here are 15 things to know about spine in ASCs.
1. The following spine procedures are typically performed in ASCs:
- Anterior cervical fusions
- Artificial cervical disc replacement
- Posterior cervical nerve root decompression
- Lumbar microdiscectomy
- Lumbar laminoforaminotomy
- Lumbar laminectomy
- Minimally invasive fusions and decompressions
- Lateral spinal fusion
2. Spine surgery is often considered the most profitable and cost-effective ASC procedure, but it is far from being the most efficient. Spine procedures typically take longer and require much more preparation and organization than other operations offered in ASCs.
3. Pain control protocols differ for ASC spine surgeries. Cathy Kowalski, RN, executive vice president and COO of Meridian Surgical Partners said in a 2008 interview with Becker's, "In addition to vastly improved technology, anesthesia has progressed, letting us do spine in the outpatient setting — anesthesiologists use shorter-acting anesthetics, and patients can go home with improved pain control, including programmable pain pumps." Since patients return home so soon after surgery, they must be educated on what they can expect in terms of protocols, complications and pain control.
4. ASCs are often forced to decide whether it's in their best interest to have a hospital partner. In August 2016, Regent Surgical Health partnered with West End Surgical in Beaverton, Ore., to develop the first surgery center in the northwest United States designed specifically for total joint and spine disorders. The partners broke ground on the 15,000-square-foot multispecialty. Regent is currently partnering with 23 surgery centers with 17 hospital partners.
5. A January 2017 study published in the International Journal of Spine Surgery examined the readmission rate for outpatient anterior cervical discectomy and fusion patients. The study included 1,528 patients and found that fewer than 6 percent of outpatient one to two level anterior cervical discectomy and fusions require readmission. No patients requiring readmission needed to stay longer than one day.
6. ASCs offer several benefits that patients won't find at standard hospitals, according to Seattle-based Microsurgical Spine Center
- Over 50 percent of U.S.-based ASCs have a zero percent infection rate
- ASCs can save some patients 50 percent in expenses
- Physician ownership makes facility and resource scheduling more efficient, leading to fewer surgical delays.
7. CMS approved 10 new ASC spine codes in 2017:
- Spine bone autograft local add-on (20936)
- Spine bone autograft morsel add-on (20937)
- Spine bone autograft struct add-on (20938)
- Additional neck spine fusion (22552)
- Insert spine fixation device (22840)
- Insert spine fixation device (22842)
- Insert spine fixation device (22845)
- Insj biomechanical device (22853)
- Insj biomechanical device (22853)
- Insj biomechanical device (22859)
8. Richard Wohns, MD, founder of Neospine in Puallup, Wash., conducted a study titled "A Comparison of the Safety of Lumbar Fusions Performed as Outpatient (<25-Hour Discharge) or Inpatient (>24-Hour Discharge) Procedures" and presented his findings at the 2012 North American Spine Society Annual Meeting. His study included 187 patients who underwent transforaminal lumbar interbody fusion; 46 percent were discharged within 24 hours or less. He found:
- Operative time: 90 minutes on average for outpatient procedures and 120 minutes on average for inpatient procedures.
- Blood Loss: 140 mL blood loss with outpatient procedures and 353 mL of blood loss for inpatient procedures.
- Exposure levels: 46 percent with minimally invasive exposures and 19 percent with inpatient procedures.
- Complication rate: three patients experienced complications in the outpatient group and seven patients experienced complications in the inpatient group. There were four in-hospital complications for the inpatient group and none with the outpatient group.
9. In discussing how spine surgeons may optimize their outpatient procedures during a 2015 interview with Becker's, Neil Badlani, MD, of Houston-based North American Spine said, "Patient education and patient selection is the most important aspect of this." In the July/August publication of Spine Surgery Today, John C. Liu, MD, of Los Angeles-based Keck Medicine of USC said, "Healthy patients with straightforward surgical plans usually will be good candidates when the surgeries are performed by experienced spine surgeons at a well-equipped and well-staffed ASCs."
10. In December 2016, Medgadget reported substantial lumbar spine fusion market growth through 2020, attributing the phenomenon to the growing number of physician-owned ASCs. Surface-modified titanium in spinal implants will also stimulate the market's expansion.
11. The global surgical navigations systems market is also expected to grow exponentially due to increased demand for spine surgery in an outpatient setting, according to a Technavio report.
12. Spine Health reports that microdiscectomies and endoscopic discectomies are the two common options in outpatient lumbar discectomies.
13. Richard N. Wohns, MD, of NeoSpine offered the following cost data on spine in the outpatient surgery setting during a 2015 interview with Becker's:
- Disposable for spine — $500
- Total cost of eight nursing hours per patient, factoring in multiple staff in room — $300 to $350
- Average implant costs — $5,000
- Average annual number of pain procedures — 2,000
14. Market.Biz reports that the global cervical total disc replacement device market is expected to hit $1.75 billion by 2021, according to InvestDailyNews. This growth is predicted to significantly impact ASCs, as more and more surgeons are performing minimally invasive cervical disc replacements in ambulatory surgery centers.
15. ASCs utilize MIS devices during spine surgeries. In December 2016, Englewood, N.J.-based The Center for Muscoskeletal Disorders used the Mazor Robotic Renaissance System during a kyphoplasty operation on a patient experiencing pain from a T12 fracture. The surgery was successful and the patient left the facility two-and-a-half hours afterwards. This is only one example of MIS devices increasing ASC spine procedures today.
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