What's holding back outpatient spine growth?

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Outpatient spine surgery has grown significantly in recent years thanks to new technologies and the adoption of minimally invasive techniques. However, some factors in the healthcare industry are slowing its trajectory.

Six spine surgeons spoke with Becker's to discuss what's holding back outpatient spine migration.

Note: Responses were lightly edited for clarity. 

Question: What is one factor holding back outpatient spine migration?

Harel Deutsch, MD. Co-Director of the Rush Spine Center (Chicago): I would say that pain management after surgery is one of the key factors limiting spine migration. Spine surgeries are painful and different patients have different responses to surgeries, with some patients having exaggerated pain responses requiring more immediate nursing care. While generally, most patients could have outpatient surgeries, it can be difficult to predict which patient will need a longer stay.

Joseph Ferguson, MD. MedStar Health (Washington, D.C.): It's really the partnership with anesthesia. You look at the places that are doing high volumes of outpatient surgery, and it's the continuum of care from the time the patient hits the surgery center until the time that they leave and how effective we are at preoperative and postoperative pain control. There's pain medicine that we administer preoperatively. We've learned a lot from our total joint colleagues about how to do anesthesia during surgery and then the recovery time after anesthesia and then pain control after the patients are discharged from same-day surgery. All of that is really almost outside of the surgeon's control, or most of it. We can do local pain medication at the time of surgery to help with that. But that's in conjunction with a lot of the things that the anesthesia providers do before, during and after the surgery.

Brian Fiani, DO. Mendelson Kornblum Orthopedic & Spine Specialists (West Bloomfield, Mich.): One factor holding back outpatient spine migration is the reluctance of some healthcare providers to adopt new technologies and techniques. Many traditional surgeons may be hesitant to change their practices and adopt minimally invasive procedures, which can limit the availability of outpatient spine surgery options for patients. Additionally, insurance coverage and reimbursement policies may not always align with the shift towards outpatient procedures, creating barriers for both healthcare providers and patients.

Arya Shamie, MD. UCLA Health (Los Angeles): One significant factor holding back outpatient spine migration is the concern over patient safety and postoperative care. Complex spine surgeries often require extended monitoring and management of potential complications, such as bleeding, infection, or neurological issues, which are more easily managed in an inpatient setting where immediate medical intervention is available if needed.

Alok Sharan, MD. Spine and Performance Institute (Edison, N.J.): There have been a lot of incentives that are pushing many spine surgeries to be performed outpatient. One factor holding it back is the lack of standardization in how we optimize patients prior to surgery. We have started an IV nutrition program that has been helpful for post-op recovery. Beyond the use of nutrition to help with wound healing, we are seeing tremendous results when we use a combination of amino acids along with nutrition to reduce inflammation. Many patients who undergo surgery with our awake spinal fusion protocol are going home within four hours of surgery, and are taking minimal opioids post surgery. As we are learning to optimize patients better prior to surgery, I am predicting that we will soon be able to offer opioid-free spinal fusion surgery.

William Taylor, MD. University of California San Diego Health: We need to develop navigation and robotics that work well in the outpatient setting.

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