ASC leaders and companies are keeping a sharp eye on the continued migration of high-acuity orthopedic procedures to the outpatient setting.
Here are five leaders' recent thoughts on outpatient orthopedics:
Eric Anderson, MD. Co-Founder of Advanced Pain Institute of Texas (Lewisville): For our practice, Sacroiliac (SI) fusion has emerged as a groundbreaking innovation in spine and orthopedics over the past year, primarily due to advancements in minimally invasive surgical techniques and cutting-edge technology. Moreover, the ability to do office-based SI fusion procedures showcases a shift towards outpatient care. This allows patients to undergo the procedure safely with minimal sedation, which minimizes anesthesia risks and promotes a quicker recovery. These innovations not only address the growing demand for effective treatments for chronic lower back pain, but also reflect a broader trend towards enhancing patient safety and reducing healthcare costs in orthopedic practices.
Nyleen Flores. Chief Administrative Officer of Lake Oconee Orthopedics (Greensboro, Ga.): With higher acuity cases coming into the outpatient space, it creates the need to really focus on what we're doing to these patients and how we are monitoring this to optimize care in the outpatient setting, which is really guided by, protected by and focused by through the credentialing peer review process within a surgery center.
I don't think that surgery centers have caught up to the standards of hospitals, but yet we are performing the same kind of procedures now. So we want to make sure that our administrators are allowing a place for credentialing and ongoing monitoring of these higher acuity cases that are being performed. We, as surgery centers, are required to maintain logs to monitor complications, and to really do the same thing that hospitals are doing. But this is still being considered just a paper function when it really is so much more.
While we continue to grow in the outpatient space, I think that there is a need to focus and educate leaders on the importance of really what credentialing is in a surgery center and where it's going … and to be able to safely accommodate these types of procedures.
Brandon Hirsch, MD. Orthopedic surgeon at DISC Sports & Spine Center (Newport Beach, Calif.): I think the acuity of cases done in the free-standing outpatient center is likely to continue to increase. What we're doing at our centers today are cases that many surgeons historically would perform only in hospital settings. We do anterior lumbar exposures safely and routinely because we have excellent vascular access and tried and true perioperative protocols. Surgeons at our centers have the equipment, the staff expertise and the setup to handle higher acuity spine cases. I have to imagine that other groups who are serious about outpatient spine surgery are going to make similar plans.
Over the past two decades, it has also become more and more challenging for spine surgeons to work in the hospital setting, particularly if they're not an employee of the hospital. It is also difficult for a traditional hospital to give a high-quality patient experience around spine surgery because the facility has to be able to provide care for many different health conditions at varying levels of acuity. Some inpatient facilities do this well because spine surgery is the main focus of the hospital. Unfortunately, nationwide this is more the exception than the rule. A highly specialized center that routinely does outpatient spine surgery every day is going to provide a better experience for both patients and their surgeons.
Ezriel Kornel, MD. Somers Orthopaedic Surgery and Sports Medicine Group (Carmel, N.Y.): Outpatient spine surgery will continue to grow, but it's essential to ensure patients are medically stable and suitable for this setting. Factors like pre-existing conditions or pulmonary issues may require closer monitoring, which limits the feasibility of outpatient procedures for some patients.
Pain management is another consideration. Certain patients may experience more post-operative pain, requiring overnight observation for pain control. While minimally invasive techniques reduce trauma and stress on the body, outpatient procedures won't be possible for every case or every patient. Some surgeries will always require a hospital setting for optimal care.
Dean Perfetti, MD. Somers Orthopaedic Surgery and Sports Medicine Group (Carmel, N.Y.): Over the next two to three years procedures are going to be more commonly performed in an outpatient setting — not only the 23 hour stay, but probably even shorter. Endoscopy opens up that ability to essentially be treated almost like a knee arthroscopy, where you get your surgery and within an hour or two you're discharged home. That's a big benefit of endoscopy, where you have not only small incisions from a minimally invasive point of view, but you have no dead space in terms of the dissection. Everything closes up as you take the small tube out, and it's even smaller than the tubular retractors that are 18 to 22mm that you hear in microdiscectomy. This is truly minimally invasive. Having a camera down at the level of the pathology, as opposed to looking at it from a normal standard surgical perspective, we could really deal with the problem at hand and then get people back to their lives and to work significantly quicker.