Becker's Spine Review

6 SPINE SURGEONS Leave spinal fusions to the surgeons, spine societies warn By Laura Dyrda R ecent technology advances in spine surgery allow for less invasive proce- dures and outpatient surgeries. But several spine societies have come together to warn against non-spine surgeons performing spinal arthrodesis. e American Academy of Orthopaedic Surgeons, American Association of Neuro- logical Surgeons, Congress of Neurological Surgeons, International Society for the Ad- vancement of Spine Surgery, were among the professional organizations that worked together on a position statement about spi- nal arthrodesis performed by non-spine sur- geons. e statement was adopted in October and made public Jan. 12. "As patient demand for minimally invasive techniques has increased, a significant num- ber of non-surgeon clinicians now perform arthrodesis procedures that alter the biome- chanics of the spine — despite the fact that arthrodesis of the spine remains outside the scope of training curriculum of physiatrists and pain management anesthesiologists who are currently performing these procedures," reads the statement. e statement also highlights the difference in training between spine and neurosurgeons, and non-operative specialists: "Optimal pa- tient care and patient safety are best served when surgical diseases affecting the spine are managed by neurosurgeons and orthopedic spinal surgeons trained in the full spectrum of spinal biomechanics, including instru- mentation and fusion techniques. erefore, arthrodesis or any other intervention that al- ters the biomechanics of the spine should not be performed by practitioners in other fields outside of specialty-trained neurosurgery or orthopedic spinal surgeons." n Spinal fusions at HOPDs increase after CMS approval for ASCs By Laura Dyrda O utpatient cervical and lumbar fusions jumped at hospi- tal-outpatient departments after CMS approved the pro- cedures for ASCs while the procedure rate had little or no growth in surgery centers. Optum teamed with Advisory Board to examine how CMS approval of procedures in ASCs shifted where surgeons performed proce- dures. The researchers found that procedures typically shifted out- patient slowly, and HOPD use increased at a higher rate than ASCs. The report found that cervical fusions were up 26 percent in HOPDs and 1 percent in ASCs, according to Optum's deidentified Clinfor- matics Data Mart Database. CMS data also showed that cervical fu- sions for Medicare beneficiaries were up 13 percent in HOPDs and 1 percent in ASCs between 2014 and 2019. Both Optum and CMS reported no change in lumbar fusion rates at ASCs. CMS reported that lumbar fusions were up 6 percent at HOPDs over the study period, and Optum reported a 3 percent in- crease of lumbar fusions at HOPDs. The researchers also examined sacroiliac joint fusions but found a slightly different outcome. SI joint fusions were up 18 percent for Medicare beneficiaries at ASCs and 13 percent at HOPDs. Optum, on the other hand, reported that SI joint fusions jumped 12 percent at HOPDs and 5 percent at ASCs. n Neurosurgery to be down 1,200 physicians by 2025 By Alan Condon B y 2030, the shortage of physicians in the U.S. is expected to reach 121,300, with neurosurgery among the specialties anticipating a significant deficit, according to an annual report published Jan. 26 by advisory group Physicians Thrive. Here are the 10 specialties expected to see the greatest physician deficits through 2025: 1. Cardiology: 7,080 2. Ophthalmology: 6,180 3. Orthopedic surgery: 5,050 4. Urology: 3,630 5. General surgery: 2,970 6. Cardiothoracic surgery: 1,800 7. Gastroenterology: 1,630 8. Hematology/oncology: 1,400 9. Pulmonology: 1,400 10. Neurosurgery: 1,200 n

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