Adding high acuity procedures, such as spine surgeries, to an ASC requires preparation to ensure a safe migration of these procedures to the outpatient setting.
Three spine leaders joined Becker's ASC Review to discuss what ASC staff and surgeons should know before adding spinal procedures.
Editor's note: These responses were edited lightly for clarity and brevity.
Question: What should ACSs know before adding spinal procedures?
Frank Phillips, MD. Director of the Division of Spine Surgery at Rush Unversity Medical Center (Chicago): Prior to performing more complex cases in the ASC, the surgeon should be proficient with these cases in the hospital setting. Prolonged surgery times can make recovery in the ASC environment challenging. Getting experience with these cases in a hospital outpatient setting with the option of admitting patients is like learning with "training wheels" before embarking on performing these cases in free-standing ASCs. Surgeons should partner with their anesthesia colleagues to ensure all are on the same page with ASC protocols, including appropriate patient selection criteria. This is critical for ensuring optimal patient outcomes. At the end of the day, one should never compromise patient outcomes or safety to perform cases in ASCs.
Nitin Khanna, MD. Surgeon at Spine Care Specialists (Munster, Ind.): Take your time. Build your practice. Build your skill set. Start small and build relationships with the ASC staff and anesthesia. Do the smaller cases then build to the instrumented case. Once you have become facile with the more straightforward cases, it will be a natural progression to take on the more challenging/complex cases. It is patient first and foremost. Make sure the patient is onboard with what outpatient surgery has to offer and never talk a patient into an outpatient surgery.
Richard Kube, MD. Founder and Surgeon at Prairie Spine & Pain Institute (Peoria, Ill.): Take a scientific approach. The first case I did in an ambulatory environment wasn't a complex case. You need to really study the cases that you're doing. Be honest about your outcomes. Look at the numbers, and run the numbers. What's the patient's pain like? When are they ambulating? I think you really need to be honest with the types of procedures you do. How mobile are these people? How can they get up and move around? What is my real complication rate? How often do I have to transfuse people? If you have a patient who you're pushing the envelope on the health of the individual, you're going to have a problem. Respect your anesthesia team, take their advice, talk to them about these people, make sure that they're comfortable with who you're signing up for an operation. Make sure that they're reliable.