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19 OUTPATIENT SPINE 5 Best Practices for Spine Surgery in ASCs By Laura Dyrda A study published in Spine used a Delphi panel to identify best practices for out- patient anterior cervical spine surgery. e panel of three neurosurgeons, three an- esthesiologists, one orthopedic spine surgeon and a registered nurse conducted a three- round modified-Delphi method to generate best practice statements. e predetermined consensus was 70 percent for each best prac- tice statement related to cervical spinal fusion and cervical total disc replacement in ASCs. e panel initially reviewed 94 consensus statements and achieved consensus on 83. "Given a paucity of guidelines and a lack of established care pathways for ACDF/CTDR in same-day, ambulatory settings, results from this study can supplement available ev- idence in support of local protocol develop- ment for providers considering a transition to the outpatient environment," concluded the study authors. e consensus statements ranged from pain management to patient selection and surgical technique. Here are five key notes on the best practices: 1. Patient selection — the patient's age, BMI over 35 kg/m2 and previous anterior surger- ies shouldn't preclude them from outpatient surgery. However, patients with severe car- diopulmonary comorbidities aren't good can- didates for outpatient surgery. 2. Pain management — to avoid opioid use, the best practice is employing short-acting anesthetic agents for outpatient spine surgery patients. Preoperative analgesia plans are necessary and the panel recommended using mild analgesics for initial pain control before administering opioids for persisting pain. 3. Patient education — the best practice is for healthcare providers to educate patients and caregivers about the goal of surgery, proce- dural details and anesthesia-related issues. Additional emphasis on expectations for postoperative care such as smoking cessation, medication use, emergency care access, warn- ing signs and wound care are recommended. 4. Aer care — panelists recommended ASCs use backed discharge checklists from first- to second-stage recovery; 80 percent recom- mended observing patients for at least three hour postoperatively and all backed postop- erative follow-up calls from a nurse the day aer surgery. 5. Payment — be proactive in payer negoti- ations and establish procedure-specific re- imbursement rates for your facility. It's also a best practice for ASC staff to confirm the patient has coverage for spine surgery in the ASC setting and notify patients of their cost obligations. ASCs can establish policies for self-pay patients. n