Spine surgery & ASCs: 3 leaders' thoughts

Here's what three orthopedic leaders have to say about the state of outpatient spine surgery:

Chester Donnally, MD. Texas Spine Consultants (Dallas): So many are already being done in an ASC that it really sets the bar high. I feel like on LinkedIn you will see a surgeon post how great they were to do a four-level lateral with perc screws and send the patient home that day from (their) ASC. The bar has been set very high for outpatient cases.

Brian Gantwerker, MD. The Craniospinal Center of Los Angeles: Patient selection remains key in doing ASC cases. It is important if the patient falls into a higher risk echelon that they be recommended for surgery in the inpatient setting. Additional tips to get patients to the ASC is hiring and maintaining properly trained staff in the OR. Selecting for very experienced staff at all phases of care will pay off in great dividends.

Technology is a double-edged sword. On the one hand it makes some surgeries deceptively simple, but in the wrong hands, it can lull some of the untrained into a false sense of security. There are a plethora of technologies on the market that are not necessarily good for patients and are being used somewhat irresponsibly and in potentially inappropriate cases. I would caution ASC managers and administrators to look at these with a somewhat jaundiced eye and use caution when dealing with those who seem to be selling a bill of goods

Richard Kube II, MD. Prairie Spine & Pain Institute (Peoria, Ill.): I have been doing ambulatory spine surgery exclusively since the fall of 2014. For that vantage point, I feel I am already doing all that can be done. Deformity and other larger cases are the only cases we do not do in the ambulatory setting, and those decisions are based more upon medical risk factors, need for transfusions, etc. In those instances, I think it will be a long time before those types of cases can be considered for outpatient facilities. Some procedures in their current format require the added capabilities a hospital setting provides for medical comorbidities as well as transfusion capabilities and convalescent care.

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