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COVER STORY


Providing High-Acuity Orthopedic and Spine Cases


Strategies for success lie in pre- and postop care BY SAHELY MUKERJI


A


rthritis and spine- and back- related conditions in adults aged


18 and older will grow from 54 mil- lion in 2014 to 63 million by 2020 and 78 million by 2040, according to the Centers for Disease Control and Prevention (CDC). To keep up with the growing demand for elective spine surgery, researchers believe outpatient settings will handle up to 50 percent of spinal surgery volume within the next few years, according to an article in the July 14, 2014, Global Spine Journal. Traditionally, these cases were done in the inpatient setting with a hospital stay of three to four days. Now, due to less invasive surgery, technological improvements and faster rehabilita- tion times, these procedures are being


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moved to outpatient facilities, such as ASCs, according to an August 22, 2013 (https://www.ncbi.nlm.nih.gov/ pubmed/23964794) study, and a Nov- ember 29, 2016 (https://www.ncbi.nlm. nih.gov/pubmed/27404852) study by the National Institutes of Health. “We have intelligently migrated spi- nal procedures to an ASC, which is a very cost-effective environment,” says Anthony L. Asher, MD, ASCA Board member, director of the Neuroscience Institute at Carolinas HealthCare System and senior partner at Carolina Neurosur- gery and Spine Associates in Charlotte, North Carolina. “By ‘intelligent migra- tion’ I mean that the safety and feasibil- ity of performing these procedures was first modeled in hospital environments, before being transferred to the outpatient


ASC FOCUS FEBRUARY 2018 |www.ascfocus.org


setting. In the beginning of our experi- ence, we performed mostly simple proce- dures, such as lumbar microdiscectomies, in our ASC. As time progressed, we were able to objectively demonstrate the safety of performing more complex procedures, such as cervical and lumbar fusions, in an ASC . . . we are now examining the safety and efficacy of performing increasingly advanced neurosurgical procedures in an ASC, such as basic craniotomies, cranial endoscopy, brain biopsies, Chiari decom- pressions not requiring durial opening and basic CSF shunting procedures.”


Preop The key to success, say the physicians who perform these high-acuity orthope- dic and spine procedures in ASCs, is care- ful patient selection.


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