Outpatient Spine Surgery: What You Need to Know

View Original Article on Spine Universe

Dwight Tyndall, MD, FAAOS talked with SpineUniverse to explain the in’s and out’s of outpatient spine surgery, potential benefits, conditions treated and surgical procedures performed.
Written by Kristin Della Volpe; Reviewed by Dwight S. Tyndall, MD, FAAOS
Peer Reviewed
Improvements in technology and surgical techniques over the past decade have allowed for more spine surgeries to be performed outside of the traditional hospital setting and in outpatient spine surgery centers. To learn more about the benefits of outpatient spine surgery centers, SpineUniverse spoke to Dwight Tyndall, MD, FAAOS, who is a leader in the growing field of outpatient spine surgery. Dr. Tyndall’s practice is devoted to minimally invasive and outpatient/same day spine surgery.

Q: What is an outpatient spine surgery center?
Dr. Tyndall: An outpatient spine surgery center is an ambulatory care facility where the staff is focused only on performing spine surgery. This degree of specialization requires the integration and commitment of the staff, since spine surgery patients need special care above and beyond what is usually offered at an ambulatory care facility.

Compared with ambulatory care facilities, outpatient spine surgery centers typically use different anesthetic techniques, strategies for moving patients, and postsurgery pain treatments.

Q: What are the benefits of having spine surgery performed in an outpatient surgery center?
Dr. Tyndall: The entire experience in an outpatient spine surgery center is geared toward allowing the patient to have the shortest possible procedure and quickest recovery, in this way they can get quickly back on their feet and back into their lives. Many patients leave the same day, which has considerable cost savings compared to an overnight stay in a hospital and may allow the patients to have a better recovery in the comfort of their home.

In addition, outpatient centers by their nature are able to provide a more personalized experience. Think of a hospital as a massive cruise ship—it has everything for everyone and often can feel overwhelming. The parking lot may be two blocks away making patient ingress and egress difficult. A surgery center typically has a smaller footprint with parking close by therefore it is easier for patients to come and go.

Q: Why are more spine surgeries being performed on an outpatient basis?
Dr. Tyndall: There are several reasons for the increase in outpatient spine surgeries, including patient demand, convenience, better patient experience, decreased cost, and the desire of some surgeons to deliver a more patient-friendly experience.

Outpatient spine surgery is a winning combination. This type of care is putting the hospitality back into healthcare and hospital business.

Q: Do the services outpatient surgery centers differ from those performed in the inpatient setting?
Dr. Tyndall: In general, outpatient surgery centers typically offer the same surgical services as hospitals. Care delivered after surgery may differ somewhat because many outpatient spine centers discharge the patient that day or the next morning. If a patient requires extensive rehabilitation or physical therapy after surgery, those services are provided on an outpatient basis so the patient can remain at home, rather than in the hospital.

Patients always have the final say in where their surgery is performed—in a hospital or in an outpatient surgery center.

Q: How do I find out if the outpatient spine surgery center is properly licensed or credentialed?
Dr. Tyndall: Most centers are licensed by the state they are located, in as well as by Medicare. Patients can inquire with the center about licensing.

Q: What types of neck and back disorders are treated in outpatient spine surgery centers?
Dr. Tyndall: Outpatient spine surgery centers mainly treat degenerative conditions, such as herniated discs, degenerative disc disease, spinal stenosis, and spondylolisthesis. Surgeries commonly performed in the outpatient setting include cervical and lumbar decompression, spinal fusion, and cervical and lumbar disc replacement.

In contrast, people who need urgent or emergency care should be treated in a hospital setting. For example, a person with a spinal fracture from a high-speed motor vehicle accident would enter the health care system through the emergency department or trauma center and be treated in the hospital. Other conditions that are best treated in a hospital include major deformity (eg, scoliosis) or spinal fractures caused by tumors or infections.

Q: Are outpatient spine surgeries limited to those involving only minimally invasive techniques?
Dr. Tyndall: Yes, outpatient spine surgery centers typically use minimally invasive techniques as these lead to shorter surgeries and less complications, allowing patients to recover more quickly.

Q: What happens if there is a complication or medical emergency during an outpatient spine surgery?
Dr. Tyndall: Patients scheduled for outpatient spine surgery are screened to make sure they do not have conditions that put them at risk for complications during surgery. However, if a complication does occur during surgery, the event is handled the same way as it would in a hospital. Outpatient spine surgery centers have the same equipment as a hospital operating room.

For example, if a patient has a heart attack during surgery, the surgery team is equipped to stabilize the patient and, if the patient needs additional treatment, would transfer the patient to a regional or local hospital.

Q: How do I prepare for an outpatient spine surgery procedure?
Dr. Tyndall: The surgery center will give you instructions on what steps to take before your procedure. For example, some people may need to stop taking certain medications before surgery. The center also will make sure that you have a family member of friend to take you home. The preparation is the same as for a hospital-based surgery.

Q: How are the costs associated with my outpatient spine surgery billed?
Dr. Tyndall: Costs for outpatient spine surgery are billed the same as in a hospital. However, the costs can be markedly lower in an outpatient center because these facilities are efficient in use of staff and resources. Also, hospitals often share costs across departments, so the cost of a surgery may be much higher in a hospital setting because of costs from other seemingly unrelated fees.

In addition, outpatient surgical centers have lower operating costs (costs to run the center) and those cost savings can be passed along to insurance companies or directly to patients who are paying out of pocket.

Q: What happens after my surgical procedure?
Dr. Tyndall: After your surgery, you will be transferred to a recovery room and discharged typically the same day or the next morning. You will be give discharge instructions by staff and booklet to take home with you with written instructions on after care.

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