Outpatient Surgery Magazine

Did Skin Prep Fuel This Fire? - February 2017 - 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.

Issue link: http://outpatientsurgery.uberflip.com/i/782943

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Page 97 of 146

sional pain are the keys to safely performing outpatient spinal fusion. Here are some tips you can follow. Get their whole health history. It's critical to stratify patients pre- operatively so you have a really good picture of their health profile before they even come to the facility. Call the patient's cardiologist, pulmonologist and nephrologist, and ask for notes. You don't want patients showing up day of surgery only to cancel them. That's a huge expense and inconvenience. Refer patients with significant comorbidi- ties to relevant specialists before scheduling for surgery. Patient selection. What's the telltale sign that a patient is ready to go home after ambulatory surgery? If he can ambulate. If he can walk the hall an hour after he's been extubated. First, don't schedule patients who can't ambulate to begin with. You want to mitigate risk. Determine their comorbidities. Patients with severe cardiopulmonary comorbidities or those on dialysis are not the kinds of patients you want to send home after spinal fusion. Can patients who are morbidly obese (BMI>35 kg/m 2 ) undergo spinal fusion in an outpatient setting? Yes, provided their comorbidities are controlled and the OR table is capable of safely holding the patient's weight. On the other hand, patients with cervical myelopathy whose functional debility is likely to necessitate inpatient rehabilita- tion after surgery should be excluded from outpatient surgery. More than 2 levels? Cervical surgeries for more than 2 levels can be performed in an outpatient setting, but surgeons planning to transi- tion patients to freestanding outpatient settings should first gain profi- ciency in lower-complexity populations within the hospital environ- ment. You don't start off doing 2 and 3 levels. If you can't control and 9 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 A N U A R Y 2 0 1 7

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