When it comes to surgery, patient safety is crucial. The patient is constantly monitored, with round-the-clock staffing prepared to deal with adverse reactions when inpatient surgery is performed.
Learn more: Outpatient Spine Surgery Considerations
In an outpatient procedure, patients leave the recovery room and go home. Friends or family members tending to the person who has had surgery must be vigilant. Fortunately, the outpatient experience has been shown to be safe for carefully selected procedures and patients.1,2
Research has shown no significant difference in complication rates for inpatients and outpatients in the situations outlined earlier in this article. In fact, some clinicians believe that outpatient spine surgery results may be better, with fewer complications, since the outpatient patient population is usually more healthy, less opioid-dependent, and with better home and social support. Those are necessary criteria to even recommend outpatient surgical procedures.
Medical Conditions with Medicare Patients
Lately, there has been quite a bit of study on outpatient surgery on the Medicare population. Age by itself is not a contraindication. Medical conditions, however, need to be considered before any surgery. Since most spine surgery is elective, it is best for the patient to optimize his or her medical condition prior to the operation.
Significant prior cardiopulmonary history, arrhythmia, and heart failure need to be evaluated before any outpatient procedure. Anesthesia can have significant effects on the heart and the fluid dynamics of the body. While the short duration of surgery may be tolerable at first, some cardiac patients have significant fluid shifts that may lead to increased cardiac stress hours after the surgery.
In that situation, an inpatient admission for monitoring may be more prudent. For anyone with a cardiac history, the anesthesia staff will often suggest an evaluation with a cardiologist to make sure outpatient surgery is not a significant risk.
Patients with well-controlled diabetes can usually tolerate outpatient procedures. If the diabetes is not well-controlled, there can be underlying heart and kidney issues that may add significant risk to any surgical procedure.
If a patient has any ongoing infections, most surgeons will wait until the infection has cleared before pursuing surgery. If the infection is to the spine, emergency surgery may be necessary, however. That type of surgery should be performed as an inpatient.
Obesity May Pose Added Risk
Some surgeons may choose not to offer outpatient spine surgery to obese patients for several reasons, including:
- Surgical incisions are often larger
- More soft tissue dissection may be necessary
- Obesity is often linked to other medical conditions
- There is the potential for more postoperative pain and complications for more obese patients
It may be safer to admit the obese patient to the hospital for post-operative management.
Deep Venous Thrombosis Requires Monitoring
Patients at risk of deep venous thrombosis (DVT), or with a prior history of DVT, should have pre-operative testing to make sure that is not an issue during the operation. For those at a high risk, admission to the hospital with postoperative testing prior to discharge may be a prudent way to manage the risk.
If the patient cannot quickly return to ambulation activities after spine surgery, admission and monitoring until they become more active may be the safer option.
Family or Social Support Needed
Patients should not go home alone after surgery. If there is no one capable or willing to care for the person after the operation, inpatient admission is the safer alternative.
Proper Counseling Plays Role in Expectations
Patients who do not have a good grasp of the nature of the surgery and the various modes of pain control, or who are not realistic about the likely level of pain after surgery, probably should not have the procedure performed as an outpatient.
Unrealistic expectations, both for the overall goal of surgery as well as the nature of the outpatient procedure, should give everyone involved pause before even scheduling the surgery. The patient should be confident the procedure will work and have a sound knowledge of the short-term goals, procedures, and requirements to give the best chance of a good outcome and satisfaction.
For the carefully selected patient, outpatient spine surgery has the same level of outcome without added risk compared with inpatient admissions. In addition, there is the advantage of recovery at home, with family and friends. For some, there is a significant financial benefit to having the procedure performed as an outpatient as there may be reduced expenses for surgery. Overall, there is increased satisfaction with outpatient surgery, and for select spine procedures and spine patients, it is an excellent option.
- Helseth Ø, Lied B, Halvorsen CM, Ekseth K, Helseth E. Outpatient Cervical and Lumbar Spine Surgery is Feasible and Safe: A Consecutive Single Center Series of 1449 Patients. Neurosurgery. 2015;76(6):728-37; discussion 737-8.
- Bekelis K, Missios S, Kakoulides G, Rahmani R, Simmons N. Selection of patients for ambulatory lumbar discectomy: results from four US states. Spine J. 2014;1;14(9):1944-50.