Spine surgeon Peter Miller, MD, PhD, has performed minimally invasive surgery for years, and in recent years, he’s adopted an approach to support patients beyond the operating room.
Dr. Miller, of Iredell Memorial Hospital in Statesville, N.C. spoke with Becker’s about the program and why he feels a holistic approach to patient care will be important to the specialty.
Note: This conversation was lightly edited for clarity.
Question: What are some of the top opportunities for minimally invasive spine surgery in your practice?
Dr. Peter Miller: It’s been a game changer for us, switching over to minimally invasive procedures. The primary thing is it’s much easier on patients. My average length of stay is very slightly over one day, so our patients either go home that day or the next day, even for multilevel fusions. Part of what helps with that is we have a cognitive behavioral therapy program where patients have a one-time class that they go to pre-operatively to help them manage expectations and understand what their course is going to be after surgery. Pretty much everyone, even patients in their 80s, will go home the next day. To get patients mobilized quickly, we use an enhanced recovery after surgery program in terms of anesthesia and pre-operative preparation, so that also helps patients get through very quickly and easily.
I think that’s one of the biggest areas where we’re going to see improvements in spine care in the future — looking at the patient as a whole and asking ourselves as surgeons, what we can do to get this person through their needed surgery with the least trauma to the patient and enable the quickest recovery.
Q: Can you share more about how you support patients ahead of surgery? What are some common expectations or misconceptions you hear?
PM: Many patients have an idea that minimally invasive surgery can be better than open surgery. When you explain to them that we’re going to do the surgery through a tube and you’re going to be up and around that night and go home the next day, that’s more attractive to them.
I don’t think there’s many patient fears about minimally invasive spine surgery, but there’s patient fears about surgery in general, particularly in people who may have had spine surgery before. As with most surgeons, I see a lot of patients that need reoperations or revisions. And as you start laying out the differences between the open approach versus mentally invasive patients find that very attractive.
As far as the cognitive behavior program, I’ve always been concerned with the patient as a whole. It’s not enough to be technically proficient and do an excellent operation. Our goal is really to get the patient through with the least amount of stress and have the procedure be done as perfectly as possible. We’ve phased in our behavioral health over the last few years. The preoperative portion is a class. Our nurse gives a class to our patients. It’s very short and under 45 minutesThe class goes over what the patients can expect during the day, during the surgery, what’s going to happen to them and what’s going to happen to them in the postoperative period. A nurse answers any questions they have and teaches them some cognitive behavioral techniques for relaxation techniques to help in the postoperative period.
We’ve gotten a lot of positive feedback from patients because they understand that the mere fact we’re trying to help them get through the surgery as easily as possible. They understand they’re not just here for a procedure, and we want to try to get them through as a person with the least amount of stress.
