Witiw Christopher D, Wilson Jefferson R, Fehlings Michael G, Traynelis Vincent C
Rush University Medical Center, Chicago, IL, USA.
University of Toronto, Toronto, Ontario, Canada.
Global Spine J. 2020 Jan;10(1 Suppl):29S-35S. doi: 10.1177/2192568219849391. Epub 2020 Jan 6.
Narrative review with commentary.
Present healthcare reform focuses on cost-optimization and quality improvement. Spine surgery has garnered particular attention; owing to its costly nature. Ambulatory Surgical Centers (ASC) present a potential avenue for expenditure reduction. While the economic advantage of ASCs is being defined, cost saving should not come at the expense of quality or safety.
This narrative review focuses on current definitions, regulations, and recent medical literature pertinent to spinal surgery in the ASC setting.
The past decade witnessed a substantial rise in the proportion of certain spinal surgeries performed at ASCs. This setting is attractive from the payer perspective as remuneration rates are generally less than for equivalent hospital-based procedures. Opportunity for physician ownership and increased surgeon productivity afforded by more specialized centers make ASCs attractive from the provider perspective as well. These factors serve as extrinsic motivators which may optimize and improve quality of surgical care. Much data supports the safety of spine surgery in the ASC setting. However, health care providers and policy makers must recognize that current regulations regarding safety and quality are less than comprehensive and the data is predominately from selected case-series or comparative cohorts with inherent biases, along with ambiguities in the definition of "outpatient."
ASCs hold promise for providing safe and efficient surgical management of spinal conditions; however, as more procedures shift from the hospital to the ASC rigorous quality and safety data collection is needed to define patient appropriateness and track variability in quality-related outcomes.
带有评论的叙述性综述。
当前的医疗保健改革侧重于成本优化和质量提升。脊柱手术因其成本高昂而备受关注。门诊手术中心(ASC)是一种潜在的降低支出途径。虽然ASC的经济优势正在得到界定,但成本节约不应以牺牲质量或安全为代价。
本叙述性综述聚焦于ASC环境下与脊柱手术相关的当前定义、法规及近期医学文献。
在过去十年中,ASC进行的某些脊柱手术比例大幅上升。从支付方角度来看,这种环境很有吸引力,因为其报酬率通常低于同等的医院手术。从提供者角度来看,医生所有权机会以及更专业中心带来的外科医生生产力提高也使ASC颇具吸引力。这些因素是外在激励因素,可能会优化和提高手术护理质量。许多数据支持ASC环境下脊柱手术的安全性。然而,医疗保健提供者和政策制定者必须认识到,当前关于安全和质量的法规并不全面,且数据主要来自选定的病例系列或存在固有偏差的比较队列,同时“门诊病人”的定义也存在模糊性。
ASC有望为脊柱疾病提供安全有效的手术管理;然而,随着更多手术从医院转向ASC,需要严格收集质量和安全数据,以确定患者的适宜性并跟踪质量相关结果的变异性。