Archive February 2017 XVIII, No. 2

Secrets to Safe Same-Day Spinal Fusion

Anterior cervical surgery is all about patient selection and pain management.

W. Bradley Worthington

W. Bradley Worthington, MD

BIO

anterior cervical discectomy and fusion SPINAL FUSION Outpatient surgery for anterior cervical discectomy and fusion is a safe and favorable option for suitable patients.

Nowadays, you measure the length of stay for spinal fusion surgery in hours, not days: 3 to 31⁄2 hours from entrance to discharge for a lumbar laminectomy and 6 hours for an anterior cervical discectomy. How do you get patients street-ready so quickly? You closely screen and stratify suitable candidates, and you manage their pain.

Same-day ambulatory spinal fusion is becoming a preferred option for both patients and providers, spurred by minimally invasive surgical techniques that let surgeons perform spine fusions with less tissue trauma and multimodal pain management protocols, as well as favorable economics. Patient selection and managing post-operative incisional 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 comorbidities to relevant specialists before 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 comorbidities 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/m2) 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 rehabilitation after surgery should be excluded from outpatient surgery.

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