Outpatient spine surgery is accelerating, and physicians are planning for what the landscape will look like by 2030.
Here’s how five spine surgeons are approaching the outpatient boom.
Editor’s note: Responses were lightly edited for clarity.
Question: How will your approach to outpatient spine surgery change in the next five years?
Steven Girdler, MD. DISC Sports & Spine Center (Newport Beach and Marina del Rey, Calif.): Over the next five years, I expect a large portion of spinal care to continue shifting from inpatient hospitals to ambulatory surgery centers as more procedures become safely and efficiently performed in the outpatient setting. Advances in minimally invasive techniques, anesthesia, and enhanced recovery protocols will expand the types of surgeries appropriate for ASCs, giving surgeons greater control over the care environment and improving workflow consistency.
For patients, this transition means lower costs, reduced infection risk, smoother perioperative experiences, and faster recovery at home. For the healthcare system, it decreases hospital burden and supports more cost-effective, value-driven care. ASCs will increasingly become the standard setting for many spine procedures, benefiting patients and the broader system alike.
Jordan Iordanou, MD, PhD. McHugh Neurosurgery (West Islip, N.Y.): Over the next five years, I anticipate expanding outpatient spine surgery by adopting enhanced recovery protocols and advanced imaging for precise interventions. Investments in ASC infrastructure will support more complex procedures. My practice will focus on patient selection and perioperative optimization to ensure safety and efficacy in outpatient settings.
Vijay Yanamadala, MD. Hartford (Conn.) HealthCare: The trend toward outpatient procedures will likely accelerate due to cost pressures and improved perioperative care protocols. Enhanced recovery after surgery protocols, better pain management strategies, and patient selection refinements enable more procedures to be performed safely on an outpatient basis. However, this requires robust patient selection criteria, standardized protocols for complication management, and clear pathways for emergency care access. The expansion will likely be procedure-specific and institution-specific based on capabilities and experience.
Jacky Yeung, MD. Yale School of Medicine (New Haven, Conn.): The most exciting evolution is the rapid expansion of endoscopic techniques. I’ve adopted endoscopic approaches across the entire spine, not just the lumbar region, which is where most surgeons stop. This wider application truly transforms what we can offer in the outpatient setting.
With proper case selection and modern technology, we’re now able to tackle conditions that were once strictly inpatient, such as thoracic disc herniations and even cervical myelopathy, using fully endoscopic techniques. These procedures can be performed safely and effectively in an ambulatory environment with minimal tissue disruption, faster recovery, and lower complication rates.
Over the next five years, I see outpatient spine surgery becoming defined by this philosophy, using precision, visualization, and minimally invasive access to expand the boundaries of what’s possible, while always prioritizing patient safety and outcomes.
Christian Zimmerman, MD. St. Alphonsus Medical Group and SAHS Neuroscience Institute (Boise, Idaho): In my view, the die is cast with respect and expectation to outpatient surgery management and has been for a number of years. Inpatient spinal post-surgical care is reserved for the most complex of diagnosis and treatments or the highest acuity patients requiring assistance with comorbid potentials. These are pronounced standards of outcome and are reportable metrics to health system and indemnity alike. Albeit, predicting the future in healthcare is best data-realized retrospectively; the outlook portends further tightening and scrutiny in elective surgical fields, subsequently strengthening the already imposed outpatient criteria. Over time and surgeon-practice dependent, the expectation by patients of minimalizing approaches, preferred pain control methods and immediate therapy interventions will further reinforce discharge criteria and confidence.
