Outpatient Surgery Magazine

Compounding Disaster - July 2016 - Subscribe to Outpatient Surgery Magazine

Outpatient Surgery Magazine, providing current information on Surgical Services, Surgical Facility Administration, Outpatient Surgery News and Trends, OR Excellence and more.

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Page 117 of 168

wider acceptance of ASC-hosted spine. • Hesitant patients. A great many patients who may have been intimi- dated away from spine surgery by the perceived pain, length or intensity of recovery from open procedures can now be candidates, with the help of rigorous selection criteria that bring healthy, motivated patients with few comorbidities. Much credit is due to our colleagues in anesthesia, with their regional blocks and long-lasting agents before and after sur- gery. • Reluctant payers. The biggest challenge for same-day spine is going to be getting Medicare and commercial insurers to pay for the proce- dures. For that we'll need more clinical evidence that minimally invasive, outpatient spine stabilization works just as well or better than traditional methods. Muscle-sparing surgery We wouldn't even having this hospital-ASC debate were it not for the muscle-sparing minimally invasive techniques that make same-day spine surgery possible. While traditional methods split the muscle to gain access to the spine, the resulting drain insertion and pain control necessi- tate an overnight stay, at least. Major spine procedures may still require such open surgery, but any case that preserves muscle has outpatient potential. By reducing tissue trauma, the muscle-sparing approach lowers intraoperative blood loss, the need for post-op pain meds and the risk of surgical site infection. In addition to delivering better cosmetic results, it may also prevent the long-term deterioration that the stress of surgical muscle damage may wreak on adjacent tissue. Two innovations have made muscle preservation practical and accessi- ble in spine surgery: mechanical assistance in the form of tubular retrac- tors, and an alternative approach made possible by new thinking on patient positioning. 1 1 8 • O U T PA T I E N T S U R G E R Y M A G A Z I N E • J U L Y 2 0 1 6

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