Becker's ASC Review

18 ORTHOPEDICS and discectomies. I do see getting more complex surgeries including anterior cervical discectomies and fusions and lateral and posterior lumbar fusions to the ASC setting soon. Safe use of the ASC setting for complex surgery requires us to have: 1. Clear patient expectations that they will return home. 2. Clear protocols for emergency care and processes for inpatient admission should it become necessary. is is perhaps the most important part of the process. ere should never be a surprise when it comes to surgery. However, being prepared for the unexpected is essential as a surgeon or as an anesthesiologist at an ASC. 3. Standardized algorithms to assess who will be a good candidate (patients with limited comorbidities, low ASA classification). 4. Home care paradigms including nursing, physical therapy, wound care that may not be necessary for simpler surgeries but will be increasingly necessary for more complex surgeries. 5. A team that can help translate complex surgeries from the hospital to the ASC. If possible, having the same team for the first several cases for a new procedure in the ASC can help ease the transition and ensure efficiency. Christian Zimmerman, MD. St. Alphonsus Medical Group and SAHS Neuroscience Institute (Boise, Idaho): e answer to this paradoxical question is the level of care for acuity-based diagnosis and the comparable specialty of deliverable care these institutions do not provide. Most surgery centers are not equipped with complex post-operative care from a physician nor advanced nursing standpoint, (ICU and step-down units). Not having this level of care should deter most presupposing surgeons from performing complex surgeries based on safety issues and true patient-centric concerns. e other ramp up would include multiplex anesthesia services, with both capability and willingness to manage these complex patients intra/post operative. n Cervical disc replacement on the rise, ACDF leveling out: A 10-year review By Carly Behm C ervical disc replacement has increased significantly from 2011 and 2021 while anterior cervical discectomy and fusion plateaued, according to a study published Feb. 24 in The Spine Journal. Four things to know: 1. Researchers used the PearlDiver database to analyze patient demographics, complications and revisions for ACDF and cervical disc replacements between 2011 to 2021. More than 404,000 ACDF and more than 29,000 cervical disc replacement patients were included. 2. Cervical disc replacements rose by 654.24% between 2011 to 2019 but plateaued. ACDF saw a smaller uptick of 25.25% in the same time and also plateaued. 3. ACDF and cervical disc replacements had overall complication rates of 12.20% and 8.77%, respectively. The most common complications were subsequent anterior revision and dysphagia. ACDFs, especially those who had multilevel procedures, tended to have more complications and higher revision rates than cervical disc replacements. 4. The study concluded, "Although a lack of radiographic data in this study limits its power to recommend either procedure for individual patients with cervical radiculopathy or myelopathy, CDA may be associated with minor improvement in the complication and revision profile." n Value-based care hit a 'stumbling block': 1 orthopedic surgeon explains why By Carly Behm V alue-based care is a hot topic in orthopedic care, but its lack of consensus among payers, patients and physicians has been an obstacle, Michael Havig, MD, said. Dr. Havig, an orthopedic surgeon at Naples, Fla.-based OrthoCollier, spoke with Becker's about what value-based care needs to take off. Note: is conversation was edited for clarity and length. Becker's Spine Review: How would you describe the state of value- based care in orthopedics? Dr. Michael Havig: From a physician perspective we always want to take good care of our patients and get them better. In exchange for that, we want to be paid a reasonable fee in a timely fashion without a lot of headaches. I think a lot of physicians think of value-based care as a different way to interact with payers and be rewarded for quality and patient satisfaction. One of the problems we've run into is everybody agrees that lowering costs and improving quality and improving the patient experience are all important. It just seems like people have struggled to figure out how to do that. So how do you do that? What does it mean to have a value-based care program? I think we've kind of hit a stumbling block in that a lot of hospital systems and big incumbent players embrace this concept but I don't really see it being practiced so much on a daily level as a physician. I think the state of value-based care is in a little bit of limbo right now. I

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