Three decades ago, spine surgery – along with just about every other type – was done in a hospital, with patients staying days or longer to recover after their procedures. But the explosion of ambulatory surgical centers in the United States since the 1980s – combined with increasingly sophisticated, minimally invasive spine surgery techniques – has led to many of these operations being done on an outpatient basis, saving patients time and money at no expense to safety, says Kaixuan Liu, MD, PhD, founder and president of Atlantic Spine Center.
A huge driver of the move toward outpatient spine surgery is the growth of ambulatory surgical centers, where patients go home the same day surgery is performed. In 1988, there were 1,000 such centers nationwide; in 2015, that number reached 5,400, according to the Ambulatory Surgery Center Association.
The range of spine surgeries that can be done at ambulatory surgical centers is steadily expanding, says Dr. Liu, who is fellowship-trained in minimally invasive spine surgery. They include procedures such as neck and spine fusion, lower back disc surgery and decompression of the spinal cord, among others.
Not everyone is a candidate for outpatient spine surgery, Dr. Liu notes – it depends both on the patient and the exact procedure they’re undergoing. But health experts are now predicting that 50% of all spine surgeries will be performed on an outpatient basis within the next five years, according to a 2014 study in Global Spine Journal. Back in 2005, that number hovered around only 5%, according to Blue Chip Partners, a manager of ambulatory surgery centers.
Array of innovations led to more outpatient spine operations
Constantly advancing technology has fueled outpatient spine surgery’s emergence as a popular option among physicians and patients in recent years, Dr. Liu says.
For example, tubular retraction systems with specialized tools – which require only tiny incisions for surgeons to access the spine – also spare excess cutting of delicate muscle tissue, which can take longer to heal. Similarly, high-powered microscopes and endoscopes enable physicians to see inside smaller surgical sites without sacrificing accuracy. Doctors can now also access the spine from alternative approaches, such as the side, which also spares muscle disruption.
“Minimally invasive spine surgery is becoming more successful for a lot of reasons – not the least of which is that surgeons are doing increasingly better at using all of these advanced tools to benefit patients,” Dr. Liu explains. “We also educate patients better these days about the realities of surgery and recovery and work with anesthesiologists to use a variety of pain control methods that allow outpatient spine surgery to be done more safely.”
Tips on benefits of outpatient spine surgery
From the patient’s vantage point, the prevalence of outpatient spine surgery offers many benefits, Dr. Liu says. They include:
- Smaller incisions
- Less bleeding
- Less pain
- Quicker recovery
- Greater comfort recovering at home than in a hospital
- Lower costs, since the expense of an overnight hospital stay is eliminated. “Similarly, health insurers are less likely to balk at procedures that don’t require hospitalization,” Dr. Liu says.
- Lower infection risks at home than in hospitals
“The trend toward outpatient spine surgery will only continue to surge,” Dr. Liu says. “More and more surgeons are learning and improving their proficiency at minimally invasive techniques, and these procedures help patients return to their favorite activities more rapidly than ever. It’s a win-win situation for everyone.”