Issue link: https://beckershealthcare.uberflip.com/i/1439613
22 Thought Leadership Spine surgery in 5 years: 5 surgeon predictions By Alan Condon O ver the next five years, minimally invasive technologies such as robotics and endoscopy are expected to become more prominent in spine surgery, and hospitals may be used only for complex cases on patients with significant comorbidities. Five surgeons discuss the future of spine care in the outpatient setting and how they see technology evolving in the specialty. Question: In five years' time, what will outpatient spine sur- gery look like? Grant Shifflett, MD. DISC Sports & Spine Center (Newport Beach, Calif.): How about what I hope to see? My hope would be that we look back in five years congratulating ourselves for the monumental progress we have made in shiing cases to the outpatient world, and see these past couple years as a tipping point in that precipitous move- ment. I hope providers will find themselves having difficulty finding reasons to do spine cases in the hospital. I hope insurers will see the incredible cost savings and the value add of shiing volume out of the hospitals. I also hope that providers who make wise decisions about treating patients with minimally invasive and motion-preserving techniques are recognized and rewarded by the system. I think if you're not on the train that's moving patients to the outpatient environment now, you'll be in an increasingly isolated position in five years. Michael Goldsmith, MD. e Centers for Advanced Orthopaedics (Bethesda, Md.): We currently perform the majority of cervical disc arthroplasty and lumbar discectomy/laminectomy surgeries, as well as select lumbar fusions, in the outpatient setting. Over the next five years, I anticipate the volume of lumbar fusions performed in the out- patient setting will significantly increase. To accomplish this, spine surgeons will need to work alongside anesthesiologists to control pre- and postoperative pain to allow the patient to mobilize and return home more quickly. Communicating with patients about the expec- tations of a successful outcome of a lumbar fusion in the outpatient setting will also be key to this transition. Issada ongtrangan, MD. Microspine (Scottsdale, Ariz.): I antic- ipate that more spine surgeries will be performed at ASCs. ere will be more investment in less-disruptive surgery such as endoscopy, nav- igation, robotics, etc. However, the more complex cases or high-risk cases such as major deformities, tumors and infections will still be performed in the hospital. In the ASC setting, there will be more col- laboration among specialists. Anesthesiologists or CRNAs will help to do postoperative blocks like erector spinae or [transversus abdominis plane] blocks. ere also will be a significant reduction in opioid use. Physical medicine will help with prehab and the acute post-op phase. Brian Gantwerker, MD. e Craniospinal Center of Los Angeles: I believe we will see a large amount of spine surgery volume being done outpatient. As endoscopic procedures get more popular and preva- lent, we may see more of those done as well. What I hope to see is more anterior lumbar fusions and arthroplasties done at ASCs. e comfort level of both approach surgeons and the spine surgeons will most likely grow in the future, and I think payers will really start to see the value in these procedures being done in an ASC. Christian Zimmerman, MD. Saint Alphonsus Medical Group and SAHS Neuroscience Institute (Boise, Idaho): As a result of the cri- sis-mode status borne out of the many COVID-19 surges, archetypical changes have subsequently resulted in practice patterns and admis- sion/discharge rates in spinal surgery. Recent retrospective reviews in our specialty spine clinics revealed significant changes in admis- sion criteria, procedural designation, length of stay and outcome fol- low-through for outpatient surgical designations. While the front-end preparatory work remains dogged, the approval and scheduling pro- cess is more cumbersome and involved from a staffing requirement. Intramural discussions about treatment options and postoperative care includes both provider and advanced practitioner information-shar- ing about expected length of stay and clearance for discharge. is includes spinal fusion patients who qualify through physical/occupa- tional clearance evaluations at postsurgical end. Granted, with past promotional metrics including length of stay for years, the cost con- tainment of this healthcare piece has shied again. ese changes are current and will continue to encourage more same-day surgical allow- ance per patient notification, acceptance and comorbid variability. n "I anticipate that more spine surgeries will be performed at ASCs. ere will be more investment in less-disruptive surgery such as endoscopy, navigation, robotics, etc. However, the more complex cases or high-risk cases such as major deformities, tumors and infections will still be performed in the hospital." Dr. Issada Thongtrangan, Microspine