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COVER STORY


Outcomes of Spine Surgery in an ASC


Patient selection and tracking metrics under bundled care BY SAHELY MUKERJI


T


he number of anterior cervical discectomy and fusion (ACDF)


surgeries, one of the most common spine procedures performed in the US today, continues to rise as a result of the growing elderly population in the country, says Anthony L. Asher, MD, ASCA Board member, director of the Neuroscience Institute at Carolinas HealthCare System and a senior partner at Carolina Neurosurgery and Spine Associates in Charlotte, North Carolina. “ACDF can be performed in the ASC environment with equivalent safety compared with safety in the inpatient hospital setting,” he says. “We have analyzed


1,000 consecutive patients


who underwent ACDF in an outpatient setting and our analysis demonstrated a surgical complications rate of 1 percent. Those that had complications could be


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appropriately diagnosed and managed in a four-hour ASC PACU window.” The study, “Anterior Cervical Discectomy and Fusion in the Out- patient Ambulatory Surgery Setting: Analysis of 1000 Consecutive Cases and Comparison to Hospital Inpa- tient ACDF,” was published in the June 2016 issue of Journal of Neu- rosurgery. “In an effort to decrease costs of care, surgeons can safely perform 1- and 2-level ACDFs in an ASC environment,” Asher says. “As with any health care setting, it is important to have contingency plans in place for possible emergency sit- uations even though they may occur at a frequency of 1 in 1,000 events. In appropriate patients, ACDFs per- formed in


the outpatient setting


appear to be as safe as those per- formed in the inpatient hospital set-


ASC FOCUS NOVEMBER/DECEMBER 2016


ting and, potentially, accomplished at a much lower cost.”


Patient Selection


Not all patients are candidates for pro- cedures in the ASC setting, and selec- tion criteria determined by the surgical and anesthesia teams are important, Asher says. “In general, complex surgical cases


like 3- or 4-level fusions, or procedures involving severe degenerative pro- cesses, should not be performed in an ASC setting,” says Michael Perry, MD, co-founder and chief medical director of Laser Spine Institute, headquartered in Tampa, Florida. “When looking at patients’ overall health, it is important to qualify the individual patient based on his or her comorbidities. It would be more appropriate for patients with few comorbidities to have spine surgery in an ASC than it would be for those with multiple comorbidities, who would be best handled in a hospital setting.” Scott Schlesinger, MD, founder of Legacy Spine & Neurological Special-


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