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Procedure, patient selection affects outpatient spine surgery success
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NEWPORT BEACH, Calif. — Several steps can be taken to ensure outpatient spine procedures are done as safely as possible in a way that not only benefits patients, but also adds to the value of care delivered by the hospitals and health systems in which these surgeries are performed, a presenter at the Interdisciplinary Conference on Orthopedic Value-Based Care, said.
According to Alexander R. Vaccaro, MD, PhD, president of Rothman Institute Orthopedics in Philadelphia, outpatient spine surgery has seen dramatic growth. He said this is due to lower charges and costs per case, factors like patient preference for the outpatient surgical setting and greater physician satisfaction performing spine surgery in this setting vs. the hospital setting.
In addition, Medicare’s continued addition of procedures to the ASC list of payable spine procedures has supported the growth of spinal outpatient surgery. This included the addition in late 2017 of code 22551 for neck spine fusion and removal below C2, and of code 63030 for laminotomy single lumbar, among seven other codes, he said.
“The conflict here is [Rothman Institute] will have 12 ASCs done in the next few years. An ASC is any type of facility where you finish a procedure, but the patient stays no more than 24 hours,” Vaccaro said.
Among the keys to success when developing a strategy for entering the spine outpatient arena is setting parameters for the kinds of procedures that will be done at the ASC, as well as not selecting patients with conditions that are likely to result in complications.
“You should not do anything where something can go wrong, and someone could die on the operating table,” Vaccaro said. “That’s a common-sense thing.”
With anterior cervical surgery, surgeons must be aware of and prepared for certain complications. Therefore, to do these types of cases in the outpatient setting means “you have to be a safe surgeon with common sense,” he said.
Surgeons who operate in the ASC setting also need to know how to get out of trouble, according to Vaccaro.
Therefore, because he has twice seen two of his spine patients develop epidural hematomas after 2 hours postoperatively, Vaccaro now keeps his anterior spine fusion patients overnight. – by Susan M. Rapp
Reference:
Vaccaro AR. Outpatient spine is the next big thing: Here’s how to be prepared. Presented at: Interdisciplinary Conference on Orthopedic Value-Based Care; Feb. 9-11, 2018; Newport Beach, California.
Disclosure: Vaccaro reports he receives grant support/royalties/stock options and/or consulting fees from DePuy, Medtronic, Stryker, Globus, Stout Medical, Aesculap, Alphatec, Biomet Spine, Paradigm Spine, Replication Medical, Spineology, Bonovo Spine, Dimension Orthotics Gamma Spine, LBI, SBI RI-related holdings, Gerson Lehrman, Guidepoint Global, Medacorp, ISD, ASIP, PST, ICOM, Orthobullets, NuVasive, Vertiflex, Avaz Surgical and AOSpine.