Becker's ASC Review

23 ORTHOPEDICS considerable amounts of time identifying problems within the system and pointing them out for non-medical readers. 9. Surgeons who take ownership of the issues that patients struggle with and create meaningful solutions. Gary Brock, MD. Orthopedic surgeon at Texas Orthopedic Hospital (Houston): I believe the things saving orthopedics are: 1. e best and brightest medical students are still applying for orthopedic residency programs. 2. Our leadership has been very proactive in maintaining and encouraging excellence and respect within our profession. ese programs include training opportunities around the globe and increased efforts to encourage gender and cultural diversity. 3. It remains a cost-effective specialty. Almost every family encounters a need for orthopedic care. Our orthopedic specialists enable people to return to activities they enjoy frequently, including an ability to return to work. Improved quality of life measurements are a reasonable expectation of orthopedic care. 4. It's still fun! Harvinder Sandhu, MD. Spine surgeon at Hospital for Special Surgery (New York City): 1. e shi to ambulatory surgery for many traditionally inpatient orthopedic procedures, such as spinal fusion surgery and knee and hip arthroplasty, is a trend saving orthopedics. e growth in ASCs that can service these procedures has helped reduce cost of care and has improved access to care in many communities. 2. e use of advanced technology such as robotics, augmented reality navigation and better endoscopic imaging has had a dramatic effect on patient safety and ultimately will increase the number of patients that can be indicated for musculoskeletal surgery. Scott Boden, MD. Director of the Emory Orthopaedics & Spine Center (Atlanta): Orthopedics will remain a highly valued specialty for the following reasons: 1. Orthopedic operations have the potential to give patients their lives back in a very measurable way. 2. The aging population and expectations of mobility and activity in older people will continue to increase the demand for orthopedic services. 3. Continued advancements in technology will enable better treatment of existing problems and new treatments for problems previously considered untreatable. is evolution in biologics and personalized medicine will further expand the menu of orthopedic services in the coming years. n What ASCs should know before adding spine procedures By Patsy Newitt A dding high acuity procedures, such as spine surgeries, to an ASC requires preparation to ensure a safe migration of these procedures to the outpatient setting. Three spine leaders joined Becker's ASC Review to discuss what ASC staff and surgeons should know before adding spinal procedures. Editor's note: These responses were edited lightly for clarity and brevity. Question: What should ACSs know before adding spinal procedures? Frank Phillips, MD. Director of the Division of Spine Surgery at Rush Unversity Medical Center (Chicago): Prior to performing more complex cases in the ASC, the surgeon should be proficient with these cases in the hospital setting. Prolonged surgery times can make recovery in the ASC environment challenging. Getting experience with these cases in a hospital outpatient setting with the option of admitting patients is like learning with "training wheels" before embarking on performing these cases in free-standing ASCs. Surgeons should partner with their anesthesia colleagues to ensure all are on the same page with ASC protocols, including appropriate patient selection criteria. This is critical for ensuring optimal patient outcomes. At the end of the day, one should never compromise patient outcomes or safety to perform cases in ASCs. Nitin Khanna, MD. Surgeon at Spine Care Specialists (Munster, Ind.): 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 case. 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. Richard Kube, MD. Founder and Surgeon at Prairie Spine & Pain Institute (Peoria, Ill.): 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. n

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