Issue link: https://beckershealthcare.uberflip.com/i/1503164
9 EXECUTIVE BRIEFING 3 EXECUTIVE BRIEFING LS: Navigation makes lumbar fusions, especially minimally invasive transforaminal lumbar interbody fusions and laterals, much easier. "NAV in a box" will greatly enhance the transition. VS: The main issue is proper patient selection in terms of their overall health, risk of complications, ability to mobilize quickly after the surgery, and reasonable expectations. The other important issue is achieving proper postoperative pain and nausea control by working with the anesthesiologist to develop optimal pre-, intra- and postoperative protocols. Q: What are your key considerations when migrating spine procedures to the ASC? BG: I go for cases that tend to be short and straightforward. No one wants to be in the operating room all day in the ASC — not me, the patient, anesthesiologist, nor the staff. Try to keep the cases "short and sweet" to maximize case flow and simplicity of post-op care. RG: Ask yourself: Can the procedure be safely done in the outpatient setting without increasing risk? If the answer is yes, then that case can be done outpatient. The outpatient also needs some support at home. There will still be complications wherever procedures are done; you just can't compromise your ability to deal with them. LS: Health of the patient is key. Chronic pain and morbid obesity are best initially avoided. Anyone who needs rehab or skilled nursing or with no home support is best done in the hospital. VS: First is to make sure that proper equipment is available and staff is properly trained. Second is to make sure it is financially feasible by analyzing reimbursements versus supply, implant and staffing costs. Q: How can spine surgeons consistently ensure excellent patient outcomes in the ASC? BG: With a focus on patient experience, case appropriateness, good surgeons and interventional pain physicians, and negotiating commensurate reimbursements with the payers, I think success will be likely. If you are falling short, or things are not going well, look for opportunities in case selection, pre-op clearance, or surgical factors that may be hampering you. RG: Proper surgical indications and techniques that achieve the fundamental goals of surgery ensure the best patient outcomes; the location that the procedure is performed is less critical. Ambulatory surgery is a nonissue when things go well — the trick is being able to handle complications while mitigating risk. LS: Right patient. Right procedure. Right time. Patient education. Meticulous surgical technique. Knowing your limits. Judicious adjuncts to narcotic analgesia (local anesthetic blocks and pumps, epidural steroids, etc). VS: Stick to proper patient selection and make sure the staff is properly educated to make the surgery safe and efficient. The opinions of Dr. Brian Gantwerker, Dr. Ray Gardocki, Dr. Lali Sekhon and Dr. Vladimir Sinkov are their own and not necessarily those of Stryker. 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.