Issue link: https://beckershealthcare.uberflip.com/i/1468175
18 EXECUTIVE BRIEFING Q: What innovations do we still need to move more cases into the ASC? Dr. Jeffords: The biggest innovation, I would say, is not really a technical innovation, it's more of a thought process. One of the things that I say when I give talks to surgeons at meetings about how to move cases from the hospital to the surgery center is your thought process — preparing yourself, preparing the patient and preparing the staff. The innovation is basically changing the way you think about how to manage these patients, changing the patient's expectations. Dr. Khanna: I think revision surgery and lateral surgery are being performed outpatient, although the numbers are small. One of the biggest obstacles remaining is training, as many of the prestigious spine fellowships offer minimal if any outpatient surgery training. A young surgeon will always feel more confident operating the way their mentor operated. It will be incumbent on fellowships to either directly offer or partner with surgeons that are performing routine outpatient spine surgery. This is our best opportunity to continue to move the field of spine surgery forward. Dr. Kube: From my vantage point, I don't think there are necessarily any technical surgical advances, I think most of the advances are really education on the financial models that are out there and an understanding of how access can be obtained for a great variety of things. As you start looking at the system as something new, in a different light, the costs continue to go up. There's not really a lot of true pressure for any of the current industries to drop those down. Q: There are many spine surgeons across the U.S. considering taking more complex cases to the ASC. What do they need to know? Dr. Khanna: Take your time. Build your practice. Build your skill set. Start small and build relationships with the ASC staff and anesthesia. Do the smaller cases then build to the instrumented cases. Once you have become facile with the more straightforward cases, it will be a natural progression to take on the more challenging/complex cases. It is patient first and foremost. Make sure the patient is onboard with what outpatient surgery has to offer and never talk a patient into an outpatient surgery. Dr. Kube: Take a scientific approach. The first case I did in an ambulatory environment wasn't a complex case. You need to really study the cases that you're doing. Be honest about your outcomes. Look at the numbers, and run the numbers. What's the patient's pain like? When are they ambulating? I think you really need to be honest with the types of procedures you do. How mobile are these people? How can they get up and move around? What is my real complication rate? How often do I have to transfuse people? If you have a patient who you're pushing the envelope on the health of the individual, you're going to have a problem. Respect your anesthesia team, take their advice, talk to them about these people, make sure that they're comfortable with who you're signing up for an operation. Make sure that they're reliable. Q: What are the benefits of the ASC for both the surgeon and the patient? Dr. Jeffords: From a patient standpoint, it's a much more patient- friendly environment. It's a much more efficient environment. When you go to a surgery center that specializes in one area of expertise, the patients feel like they know that everybody in that facility is there for one reason — to do orthopedic, and spine cases. We're not focusing on 20 different things. It's a very patient and family-friendly environment. Also, the infection rates tend to be lower in the surgery center. From a surgeon standpoint, the ASC is more efficient. We get special attention from the staff, and the efficiency is much greater than what we experienced in the hospitals in terms of turnover time. The opinions of Dr. Nitin Khanna, Dr. Paul Jeffords and Dr. Richard Kube are of Dr. Khanna, Dr. Jeffords and Dr. Kube and not necessarily those of Stryker. n Stryker is one of the world's leading medical technology companies that offers innovative products and services in Orthopaedics, Medical and Surgical devices, Neurotechnology and Spine to help make healthcare better. Procedural volumes, particularly with total joints, have been migrating from the hospital outpatient department to ambulatory surgery centers (ASCs). With the potential to provide over $55 billion per year in healthcare cost savings in the U.S., this shift in site of care is expected to continue beyond the post-pandemic environment. To meet the unique needs of this emerging customer, Stryker launched an ASC-focused business in 2020. With thousands of unique and clinically proven products spanning more than 20 procedural specialties, a wide range of flexible financial options and teams who understand the ASC landscape. Stryker is committed to delivering tailored solutions for ASCs to achieve their mission and goals. "When you go to a surgery center that specializes in one area of expertise, the patients feel like they know that everybody in that facility is there for one reason — to do orthopedic, and spine cases." Richard Jeffords, MD, of Resurgens Orthopaedics "Take your time. Build your practice. Build your skill set. Start small and build relationships with the ASC staff and anesthesia." Nitin Khanna, MD, of Spine Care Specialists in Munster, Ind.