Kern Singh, MD, co-founder of the Minimally Invasive Spine Institute at Rush in Chicago, recently penned an article on the safety of outpatient spine surgery for Vertebral Columns, a publication of the International Society for the Advancement of Spine Surgery.
The article responds to a USA Today and Kaiser Health News article highlighting the risk of cervical hematoma after outpatient spine surgery, among other potential complications after outpatient surgery. Here are five key points.
1. As technology advances, it has become safe to perform more complex spine surgeries in the outpatient setting, which is typically a lower cost setting. "Outpatient surgery centers are more easily accessible than large facilities, and the streamlining of services allows for maximum efficiency and minimal wait times," he wrote. "These advantages have led to outpatient surgery centers achieving an overall patient satisfaction rate of 92 percent."
2. Spine-focused ASCs have staff who are trained in outpatient spine surgery and focused on providing the high quality care for patients.
3. Complications are a concern for surgeons regardless of the operative setting, but especially for the outpatient setting because the staff are not equipped to handle a life-threatening complication. ASCs and surgeons should have an action plan to transfer patients to the hospital quickly if there are signs a complication occurred.
"Though rare, a cervical hematoma can develop in the first few hours after surgery," wrote Dr. Singh. "For this reason, patients in the outpatient setting are monitored closely during the immediate postoperative period so emergent treatment can be initiated if needed."
4. Dr. Singh cited an article published by McClelland et al., showing complication rates among outpatient cervical fusion patients from 1996 to 2016. The complication rate was 1.8 percent and mortality rate was 0.1 percent, much lower than up to 5 percent rates that have been associated with hospital-performed cervical fusions.
5. According to Dr. Singh, most ASCs where surgeons perform outpatient spine procedures are owned and operated by hospitals or health systems; however even among centers owned by surgeons, the surgeons have an obligation to prioritize patient safety.
"Surgeons must rigorously assess a patient's eligibility for outpatient surgery, as pre-existing conditions may put patients at a higher risk for complications," he wrote.
He argues that surgeons who are proficient in outpatient spine techniques and responsible patient selection can safely perform the appropriate procedures in the ASC and achieve high patient satisfaction as well as positive outcomes.