4 2 S U P P L E M E N T T O O U T P A T I E N T S U R G E R Y M A G A Z I N E J U N E 2 0 1 7
• Learning curve. We're going through a learning curve now, figuring out
what the limitations are, and making sure we can deliver what we think we can
deliver. But the number of operations that can be done outpatient is definitely
growing. We do anterior cervical discectomies, artificial disc replacement, pos-
terior cervical foraminotomy, posterior lumbar discectomies and lumbar decom-
pressions, among others. Most spine operations still can't be done outpatient,
but clearly there are a lot of bread-and-butter operations that can be, and we're
looking to do more and more.
• Patient selection. We usually work with healthier patients who don't have a
lot of comorbidities, especially for more complicated cases. But for the simpler
operations, we have a lot of patients in their 70s or 80s and we can usually get
those folks home on the same day, too. We typically make sure there's some-
body there to help them once they get home, at least for the first couple of days.
We also have our occupational therapist see them before they go, to explain
how to bend and twist, how to get up and move around, and how to get in and
out of cars.
• Cost control. The tricky part is controlling costs. Spine tends to be very
expensive. And every vendor wants to bring in the latest screws and rods and
cages, which may cost 2 or 3 times more, but which don't necessarily work any
better. And for spine, it's not just the metal implants, but also the biologics,
which can be extremely expensive. So standardizing among surgeons is very
important. If you have 7 surgeons using 7 different implants, that's going to be
very problematic. We're very aggressive in terms of cost control. We were able
to save a projected $1.8 million in implant costs this year by standardizing. We'll
let different vendors bring things in, but they have to meet our price.
OSM
