Medical Papers Outpatient

Eligibility of Outpatient Spine Surgery Candidates in a Single Private Practice

By Dr. Kingsley Chin

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Here, Becker’s ASC Review highlights 4 key points from this LES Society study conducted in part by The LESS Institute team.

Scientific Paper

Chin KR1,2, Pencle FJR2, Coombs AV3, Packer CF3, Hothem EA3, Seale JA2.

Interested medical professionals can read through the full paper, also published in Clinical Spine Surgery, here.

Study Design

Level III.

Purpose

To retrospectively review the eligibility of surgical patients meeting predetermined outpatient surgery criteria in a single-surgeon private practice.

Summary of Background Data

There is a burgeoning awareness among patients, surgeons, and insurers of the cost benefits and safety of outpatient spine surgeries. At the end of 2014, Centers for Medicare & Medicaid Services have released its final 2015 payment rules and codes for spinal decompression and fusion. This move confirms the safety of procedures being performed in the ambulatory surgery centers (ASCs).

Methods

We conducted a database review between 2008 and 2014 and identified 1625 orthopedic procedures. All nonsurgical spine procedures were excluded from the study. Eligibility for outpatient spine surgery was based on criteria generated from a combination of published standard of care for major operations and the chief surgeon’s experience. A matched cohort based on type of surgery in each facility of all spine surgery patients was created, group 1 (hospital patients) and group 2 (ASC patients).

Results

A total of 708 patients underwent spinal surgery during this time period with a 53% female population. A total of 557 of 708 (79%) patients were eligible for outpatient spine surgery. There were 210 surgical procedures in group 1 (inpatient) comprised of 72 decompression and 138 fusion procedures. In group 2 (outpatient), there were 347 procedures made up of 150 patients undergoing decompression and 197 undergoing fusion or disc replacement. To confirm that hospital procedures are eligible to be performed in the ASC, the χ test was performed. We found that ASC-eligible hospital patients can indeed be done in an ASC (P=0.037).

Conclusions

Outpatient spine surgery is feasible in 79% of patients in this single-surgeon private practice. On the basis of these results, a majority of spine procedures can be performed in an outpatient setting following our eligibility criteria.

About Author Dr. Kingsley R. Chin

Dr. Kingsley R. Chin, founder of philosophy and practice of The LES Society and The LESS Institute

Dr. Kingsley R. Chin, founder of philosophy and practice of The LES Society and The LESS Institute

Dr. Kingsley R. Chin is a board-certified Harvard-trained Orthopedic Spine Surgeon and Professor with copious business and information technology exposure. He sees a niche opportunity where medicine, business and info. tech meet – and is uniquely educated at the intersection of these three professions. He has experience as Professor of Clinical Biomedical Sciences & Admissions Committee Member at the Charles E. Schmidt College of Medicine at Florida Atlantic University, Professor of Clinical Orthopedic Surgery at the Herbert Wertheim College of Medicine at Florida International University, Assistant Professor of Orthopaedics at the University of Pennsylvania Medical School, Visiting Spine Surgeon & Professor at the University of the West Indies, Mona, and Adjunct Professor of Clinical Biomedical Sciences at the University of Technology, Jamaica.

Learn more about Dr. Chin here and connect via LinkedIn.

About Less Exposure Surgery

Less Exposure Surgery (LES) is based on a new philosophy of performing surgery, leading the charge to prove through bench and clinical outcomes research that LES treatment options are the best solutions – to lowering the cost of healthcare, improving outcomes and increasing patient satisfaction. Learn more at LESSociety.org.

The LES Society philosophy: “Tailor treatment to the individual aiding in the quickest recovery and return to a pain-free lifestyle, using LES® techniques that lessen exposure, preserve unoffending anatomy and utilize new technologies which are safe, easy to adopt and reproducible. These LES®techniques lessen blood loss, surgical time and exposure to radiation and can be safely performed in an outpatient center. Less is more.” – Kingsley R. Chin, MD

About The LESS Institute

The LESS Institute is the world leader center of excellence in Less Exposure Surgery. Our safe, effective outpatient treatments help patients recover quickly, avoid expensive hospital stays and return home to their family the same day. Watch our patient stories, follow us on Facebook and visit TheLESSInstitute.com to learn more.

About SpineFrontier

The above study utilized LES Technology from SpineFrontier – leading provider of LES Technologies and instruments – offering surgeons and patients superior technology and services.

Scientific Paper Author & Citation Details

Authors

Chin KR1,2, Pencle FJR2, Coombs AV3, Packer CF3, Hothem EA3, Seale JA2.

Author information

  1. Herbert Wertheim College of Medicine at Florida International University and Charles E. Schmidt College of Medicine at Florida Atlantic University.

  2. Less Exposure Surgery Specialists Institute (LESS Institute).

  3. Less Exposure Surgery Society (LES Society).


Soft Tissue Swelling Incidence Using Demineralized Bone Matrix in the Outpatient Setting

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Scientific Paper

Chin KR1, Pencle FJR2, Seale JA3, Valdivia JM3.

Interested medical professionals can read through the full paper, published in the Journal of the AAOS, here.

Aim

To assess use of demineralized bone matrix (DBM) use in anterior cervical discectomy and fusion (ACDF) in outpatient setting.

Methods

One hundred and forty-five patients with prospectively collected data undergoing single and two level ACDF with DBM packed within and anterior to polyetheretherketone (PEEK) cages. Two groups created, Group 1 (75) outpatients and control Group 2 (70) hospital patients. Prevertebral soft tissue swelling (PVSTS) was measured anterior to C2 and C6 on plain lateral cervical radiographs preoperatively and one week postoperatively and fusion assessed at two years.

Results

There was no intergroup significance between preoperative and postoperative visual analogue scales (VAS) and neck disability index (NDI) scores between Group 1 and 2. Mean preoperative PVSTS in Group 1 was 4.7 ± 0.2 mm at C2 level and 11.1 ± 0.5 at C6 level compared to Group 2 mean PVSTS of 4.5 ± 0.5 mm and 12.8 ± 0.5, P = 0.172 and 0.127 respectively. There was no radiographic or clinical evidence of adverse reaction noted. In Group 1 mean postoperative PVSTS was 5.5 ± 0.4 mm at C2 and 14.9 ± 0.6 mm at C6 compared Group 2 mean PVSTS was 4.9 ± 0.3 mm at C2 and 14.8 ± 0.5 mm at C6, P = 0.212 and 0.946 respectively. No significant increase in prevertebral soft tissue space at C2 and C6 level demonstrated.

Preoperative radiograph showing retropharyngeal/prevertebral soft tissue at the level of C2 vertebral body and at the level of C6 vertebral body.

Preoperative radiograph showing retropharyngeal/prevertebral soft tissue at the level of C2 vertebral body and at the level of C6 vertebral body.

Conclusion 

ACDF with adjunct DBM packed PEEK cages showed a statistical significant intragroup improvement in VAS neck pain scores and NDI scores (P = 0.001). There were no reported serious patient complications; post-operative radiographs demonstrated no significant difference in prevertebral space. We conclude that ACDF with DBM-packed PEEK cages can be safely done in an ASC with satisfactory outcomes.

About Author Dr. Kingsley R. Chin

DrKingsleyRChin_ORheadshot-768x576.jpg

Dr. Kingsley R. Chin is a board-certified Harvard-trained Orthopedic Spine Surgeon and Professor with copious business and information technology exposure. He sees a niche opportunity where medicine, business and info. tech meet – and is uniquely educated at the intersection of these three professions. He has experience as Professor of Clinical Biomedical Sciences & Admissions Committee Member at the Charles E. Schmidt College of Medicine at Florida Atlantic University, Professor of Clinical Orthopedic Surgery at the Herbert Wertheim College of Medicine at Florida International University, Assistant Professor of Orthopaedics at the University of Pennsylvania Medical School, Visiting Spine Surgeon & Professor at the University of the West Indies, Mona, and Adjunct Professor of Clinical Biomedical Sciences at the University of Technology, Jamaica.

Learn more about Dr. Chin here and connect via LinkedIn.

About Less Exposure Surgery

Less Exposure Surgery (LES) is based on a new philosophy of performing surgery, leading the charge to prove through bench and clinical outcomes research that LES treatment options are the best solutions – to lowering the cost of healthcare, improving outcomes and increasing patient satisfaction. Learn more at LESSociety.org.

The LES Society philosophy: “Tailor treatment to the individual aiding in the quickest recovery and return to a pain-free lifestyle, using LES® techniques that lessen exposure, preserve unoffending anatomy and utilize new technologies which are safe, easy to adopt and reproducible. These LES®techniques lessen blood loss, surgical time and exposure to radiation and can be safely performed in an outpatient center. Less is more.” – Kingsley R. Chin, MD

About The LESS Institute

The LESS Institute is the world leader center of excellence in Less Exposure Surgery. Our safe, effective outpatient treatments help patients recover quickly, avoid expensive hospital stays and return home to their family the same day. Watch our patient stories, follow us on Facebook and visit TheLESSInstitute.com to learn more.

About SpineFrontier

The above study utilized LES Technology from SpineFrontier – leading provider of LES Technologies and instruments – offering surgeons and patients superior technology and services.

Scientific Paper Author and Citation Details

Authors

Chin KR1, Pencle FJR2, Seale JA3, Valdivia JM3.

Author information

  • Charles E. Schmidt College of Medicine at Florida Atlantic University, Boca Raton, FL 33431, United States.

  • Less Exposure Surgery Society, Malden, MA 02148, United States. fabiopencle@thelessinstitute.com.

  • Less Exposure Surgery Specialists Institute, Fort Lauderdale, FL 33311, United States.