Lamis/fusions in ASC

[Timeoutofmind]

Hey all:

I work in an ASC on occasion. No ability to give any blood products there.

I have a surgeon that is trying to book lamis/fusions, both cervical and lumbar. Proposed arrangement of a 23hr stay and the nurses hanging out overnight.

One case in particular for this upcoming week is non-instrumented L3-S1 fusion.

I thought no way, but just wanted to make sure that is the consensus on here as well.

I was thinking maybe 1-2 level lami's max, and no fusions at all? What would a reasonable guideline be?

Anyone ever do anything like this? THAs/TKAs in an ASC?

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[okayplayer]

Real world answer: depends on the surgeon and depends on your upside in the whole thing.

 

[deleted875186]

Out of all the multilevel laminectomy and fusions I’ve done I’ve not had to transfuse anyone. Not sure how variable it is depending on the surgeon though.

 

[sevoflurane]

We do them at our ASC.

 

[sevoflurane]

Mainly posterior lamis and ACDFs.

Big posterior whacks are done at the hospitals.

 

[Orin]

Academic answer: Spine Surgery in the Ambulatory Surgery Center Setting: Value-Based Advancement or Safety Liability?

The issue really is what your systems are to deal with the events that could come up and how much of a whack it is if your transfer/72h readmission rate goes up.

 

[chocomorsel]

Real world answer: depends on the surgeon and depends on your upside in the whole thing.

What do you mean “your upside”?

 

[deleted162650]

What do you mean “your upside”?

$$$$$

And keeping surgeons happy which leads indirectly to more $$$$$

 

[sevoflurane]

$$$$$

And keeping surgeons happy which leads indirectly to more $$$$$

Yes. For 23 hr stays at our ASCs for whatever reason (acdf, multilevel lamis, THA, TKAs, etc), we provide an anesthesiologist for O/N coverage. Basically, you do nothing and are a safety net in case something rare happens (expanding hematoma s/p acdf).

This comes with a large overnight stipend for us. For the ASC and surgeon it’s still a home run... so everyone is happy.

 

[chocomorsel]

$$$$$

And keeping surgeons happy which leads indirectly to more $$$$$

I kinda thought that. But don’t want to assume and be wrong.
This is America.

 

[okayplayer]

If you’re being paid salary or hourly and not compensated appropriately for taking on extra risk, the answer is potentially different than if you are collecting the actual units for these cases or have additional compensation as described by Sevo and Salty. Although, if that’s the case, you may not be making this decision anyway.

Like I said, real world answer.