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
