5 Points on ACDF in Surgery Centers

Written by Rachel Fields | January 11, 2012 | Print  |
Anterior cervical discectomy and fusion is a surgical procedure performed to remove a herniated or degenerative disc in the cervical spine. While this procedure has been present in hospitals for some time, surgery centers are just starting to adopt it into their list of services. Neal Maerki, administrator of Bend (Ore.) Surgery Center, discusses issues to consider when adding anterior cervical disc fusion to an ASC. 1. Set tighter criteria for patients. Safety was a big issue for Bend Surgery Center when considering anterior cervical discectomy and fusion, Mr. Maerki says. "We set some tighter criteria for our patients as far as weight and BMI," he says. "Patients had to be here in town — or the patient, if they were from out of town, had to stay in town overnight and the physician has to be available the whole time."

Talk to your physicians and schedulers and set strict criteria for the patients you will accept in the surgery center. For example, Mr. Maerki's surgery center only accepts patients with relatively low BMIs who are an ASA level II or less, meaning they do not have severe systemic disease. "You really want to look for that slender patient who's going to be easy to do," he says.

2. Schedule cases early. Mr. Maerki says one of the most significant issues with ACDF is the possibility the patient will bleed into the neck from the surgical site and obstruct the airway. In this case, the wound needs to be opened immediately and the clots and blood removed by the surgeon. Because of this possibility, Mr. Maerki says ACDF cases should be scheduled as early as possible in the day. "They have to be the first patient done of the day or had to be done by 11 in the morning," he says.

He says his ASC holds each ACDF patient for a minimum of four hours, usually keeping the patient for no more than six hours. He says this surveillance period will ensure the patient does not suffer serious complications that require surgical treatment.

3. Follow up with a home health agency. While the surgery center should keep the patient in the PACU for surveillance after the procedure, Mr. Maerki also recommends building a relationship with a home health agency that will follow up with the patient twice in the evening of the day of surgery. He says at his surgery center, someone from the home health agency visits the patient at 5:00 or 6:00 p.m. and again at 9:00 p.m.

Surgery centers are often left "out of the loop" on patient complications when the complications are serious enough to warrant a hospital visit, so following up with a home health agency can improve patient safety and keep the ASC informed of any post-op issues.

4. Purchase a GlideScope for anesthesiologists.
Mr. Maerki recommends that surgery centers performing ACDF provide a GlideScope for anesthesiologists to improve airway management. Designed for a wide variety of clinical settings, GlideScope video laryngoscopes provide a real-time view of the patient's airway and tube placement and enable quick intubation.

The GlideScope can help anesthesiologists intubate the patient in a neutral head-neck position, meaning the face plane is parallel to the ceiling. This helps with jaw distraction and allows more room for tube delivery and intubation, compared to other positions that narrow the hypopharyngeal space. "With the GlideScope, aesthesia can document that they maintained the patient in neutral position while they were being intubated," Mr. Maerki says. "Our anesthesia providers have really liked having that available."

5. Hire staff with prior ACDF experience. Because ACDF requires technical skill and experience, Mr. Maerki recommends hiring surgery center staff with prior experience in the procedure. Because this may be a significant cost to your surgery center, make sure to discuss the procedure with the ASC board prior to recruiting physicians or buying equipment.

At Mr. Maerki's surgery center, a physician does a presentation to the medical advisory committee and explains why the procedure is appropriate for the surgery center. ASC leadership then goes through every cost involved in adding the procedure and determines the return on investment. For example, if your surgery center needs to add two new staff members to perform ACDF procedures, you will need significant volume and robust reimbursement to offset the extra salaries.

Related Articles on Surgery Center Procedures:
Looking Ahead: 6 Thoughts From Physicians on the Future of ASCs
Adding Endoscopic Balloon Sinoplasty to an ASC: 5 Thoughts From Neal Maerki
Orthopedic ASC Management: 8 Ways to Stay Ahead of the Game

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