state. Some of what we do wouldn't be possible otherwise. Take ante-
rior lumbar interbody fusions, for example. It's much easier to do
these cases with a 23-hour option. A vascular surgeon collaborates
with the spine surgeon to gain access to the spine and to move the
vessels, if necessary, so we can do the procedure with a higher level
of safety. Surgery centers in every state have the potential to operate
with extended hours Anyone can schedule fairly complicated cases
early in the morning and keep patients until 8 or 9 p.m., if necessary.
That opens up a lot of possibilities.
3
Patients have to get it
For outpatient spine to work, patients have to clearly under-
stand that you're not running a hospital — that from the
moment patients arrive for surgery, the emphasis is on moving them
through the process safely, efficiently and quickly. Patients need to
know they're an active participant and they're going to be out of
recovery quickly, and walking and sitting up in a chair a short time
later. We reassure them, of course. It's a big surgery, we say, and this
is how we're going to keep you comfortable and control your pain.
And we never promise they're going to be pain-free.
Educating family members is essential, too. When you have a
patient who's on board, you can't have her husband saying, "Don't
move. Don't get out of bed. Oh my gosh, you need more medicine. I
can't take her home like this."
Patients who understand and trust the process are engaged and
motivated. But they also need coaches. When they're sore, they need
someone to say: You're doing great. Let's get you out of bed and into
the shower. Patients aren't just happier; they're also less vulnerable to
infections. Fear and anxiety lead to immobility and pain. You can dra-
matically reduce that with education.
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