A study published in Spine used a Delphi panel to identify best practices for outpatient anterior cervical spine surgery.
The panel of three neurosurgeons, three anesthesiologists, one orthopedic spine surgeon and a registered nurse conducted a three-round modified-Delphi method to generate best practice statements. The predetermined consensus was 70 percent for each best practice statement related to cervical spinal fusion and cervical total disc replacement in ASCs.
The panel initially reviewed 94 consensus statements and achieved consensus on 83.
"Given a paucity of guidelines and a lack of established care pathways for ACDF/CTDR in same-day, ambulatory settings, results from this study can supplement available evidence in support of local protocol development for providers considering a transition to the outpatient environment," concluded the study authors.
The consensus statements ranged from pain management to patient selection and surgical technique. Here are five key notes on the best practices:
1. Patient selection — the patient's age, BMI over 35 kg/m2 and previous anterior surgeries shouldn't preclude them from outpatient surgery. However, patients with severe cardiopulmonary comorbidities aren't good candidates for outpatient surgery.
2. Pain management — to avoid opioid use, the best practice is employing short-acting anesthetic agents for outpatient spine surgery patients. Preoperative analgesia plans are necessary and the panel recommended using mild analgesics for initial pain control before administering opioids for persisting pain.
3. Patient education — the best practice is for healthcare providers to educate patients and caregivers about the goal of surgery, procedural details and anesthesia-related issues. Additional emphasis on expectations for postoperative care such as smoking cessation, medication use, emergency care access, warning signs and wound care are recommended.
4. After care — panelists recommended ASCs use backed discharge checklists from first- to second-stage recovery; 80 percent recommended observing patients for at least three hours postoperatively and all backed postoperative follow-up calls from a nurse the day after surgery.
5. Payment — be proactive in payer negotiations and establish procedure-specific reimbursement rates for your facility. It's also a best practice for ASC staff to confirm the patient has coverage for spine surgery in the ASC setting and notify patients of their cost obligations. ASCs can establish policies for self-pay patients.