spine surgery experience at the loveland surgery center
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Spine Surgery Experience at the Loveland Surgery Center
Loveland, Colorado
Kenneth A. Pettine, M.D., M.S.
• I.D.E. Site For Eight F.D.A. Spinal Implant Studies
• Joint Commission Accredited
Spine Surgeons – 2 (3) E.N.T. Surgeons –2 Orthopedic Surgeons –2 Pain Specialists –1 (2)
Loveland Surgery Center
Spine Surgery Definitions
Lumbar Spine Surgery – two broad categories Leg Pain Surgery
Nerve Decompression for Stenosis (Older Patient) Discectomy for Herniated Disc (Younger Patient)
Back Pain Surgery Fusion: Pedicle Screws (Posterior Approach) Artificial Disc (Anterior Approach)
Cervical Spine Surgery- Arm and/or Neck Pain –Anterior Cervical Fusion Posterior Cervical Surgery is rare
Equipment Requirements
General Surgeon
Cell Saver
Implants
C-Arm
Cloward or Equivalent TableC-ArmRetractors/KerisonsHigh Speed BurrImplants –Screws/Rods/CagesBone GraftCell SaverDural Tear Instruments
Posterior Lumbar Interbody Fusion (P.L.I.F.)
Anterior Lumbar Artificial Discs/Fusion (A.L.I.F)
Anterior Cervical Fusion (A.C.F) or Artificial Disc Replacement
C-Arm
Implants
Bone Graft
Specialized Retractors
High Speed Burr (Possible)
Lumbar Spine Decompression
Dural Tear Instruments
Cloward or Equivalent Table
C-Arm
Retractors
Kerisons
No Implants
Spine Implant Costs
Facility Fee Case Rate For
ACF- $6,500.00 PLIF- $8,500.00
Implant Costs ACF
1 Level - $4,500.00 2 Level - $7,325.00
PLIF 1 Level - $21,000.00 2 Level - $32,000.00 3 Level - $44,200.00
The Spine JournalThe Spine Journal
7 (2007) 148-153
The safety of instrumented outpatient anterior cervical discectomy and fusion
Alan T. Villavicencio, MD, Evan Pushchak, BA, Sigita Burneikiene, MD, Jeffrey J. Thramann, MD.
SpineSPINE
Volume 32, Number 10, pp 1135-1139
Outpatient Lumbar Spine Decompression in 233 Patients 65 Years of Age or Older
Natalie M. Best, BS, and Rick C. Sasso, MD.
Spine Surgery At Ambulatory Surgery Center
Anterior Cervical Fusions (One Level, Possible Two and Three)
Lumbar Nerve Decompressions
Discectomies
Spine Surgery at Ambulatory Surgery Center with Convalescent License
Lumbar Fusions Anterior/Posterior
Lumbar Artificial Disc Replacement
Instrumented Spine Surgery375 Patients
(Every Instrumented Spine Surgery Analyzed, Between Spring 2003 And Spring 2006)
Anterior Cervical Fusion 1 Level : 87 Patients 2 Level : 63 Patients
Posterior Lumbar Fusion 1 Level : 84 Patients 2 Level : 50 Patients 3 Level : 12 Patients
Lumbar Artificial Disc : 61 Patients
Results of Anterior Cervical Fusions (ACF) (148 Patients)
Time In OR 1 Level : 81.72 Min. (87 Patients) 2 Level : 84.43 Min. (61 Patients)
Time In PACU 1 Level : 92.54 Min. 2 Level : 80.80 Min.
Convalescent Care 1 Level : 20.68 Hours 2 Level : 20.33 Hours
Peri-Operative Complications = NoneUnplanned Transfers = None
63.27
24.63
7.52.71
0
10
20
30
40
50
60
70
Neck Disability Index Visual Analog Scale
Pre-op
Post-op
63.97
41.96
7.884.07
0
10
20
30
40
50
60
70
Neck DisabilityIndex
Visual AnalogScale
Pre-op
Post-op
Mean Change From Pre-op to One-Year Post-op in Patients
Undergoing One-Level ACF
Mean Change From Pre-op to One-Year Post-op in Patients Undergoing
Two-Level ACF
Patient Satisfaction Rates One Level ACF
Convalescent care room: 95% (CCR) Pain control: 98% (PC) Food in the convalescent care unit: 93% (Food) Nursing care: 97% (NC) Overall experience: 95% (OE)
0.95
0.98
0.93
0.97
0.95
90%
91%
92%
93%
94%
95%
96%
97%
98%
CCR PC Food NC OE
Patient Satisfaction Rates Two Level ACF
Convalescent care room: 99% (CCR) Pain control: 93% (PC) Food in the convalescent care unit: 93% (Food) Nursing care: 99% (NC) Overall experience: 96% (OE)
90%
91%
92%
93%
94%
95%
96%
97%
98%
99%
CCR PC Food NC OE
Conclusion Of A.C.F. Data
Clinical Results of Improvement in V.A.S. and N.D.I. Are Statistically Significant. A.C.F. Can Be Safely Performed With Efficacy At An A.S.C.
Lumbar Fusion146 Patients
Time In O.R.
1 Level : 157.51 Min.
2 Level : 186.09 Min.
3 Level : 213 Min.
157.51
186.09
213
0
50
100
150
200
250
1 Level 2 Level 3 Level
Lumbar Fusion146 Patients
Time In P.A.C.U.
1 Level: 77.59 Min.
2 Level: 85.79 Min.
3 Level: 91.07 Min.
77.59
85.79
91.07
70
75
80
85
90
95
1 Level 2 Level 3 Level
Lumbar Fusion 146 Patients
Time In Convalescent Unit
1 Level: 42.10 Hours
2 Level: 50.07 Hours
3 Level: 55.11 Hours
42.1
50.0755.11
0
10
20
30
40
50
60
1 Level 2 Level 3 Level
Peri-Operative Complications
Return To O.R. To Drain Fluid = 1 Patient
No Nerve Injuries, Infections, Vascular Problems
Unplanned Transfers To Hosp./Rehab Rehab Unit = 2 Patients Hospital = 1 Patient, Oxycontin Reaction
Causing Excessive Sedation
Clinical Results Of Lumbar Fusion At 1 Year Follow-Up One Level
44.1340.33
6.883.9
05
101520
2530
354045
OswestryDisability Index
Visual AnalogScale
Pre-opPost-op
Mean Change From Pre-op to One-Year Post-op in Patients Undergoing Third-Level PLIF
Clinical Results Of Lumbar Fusion At 1 Year Follow-Up Two Level
61.1
40.64
8.674.88
0
10
20
30
40
50
60
70
OswestryDisability Index
Visual AnalogScale
Pre-opPost-op
Mean Change From Pre-op to One-Year Post-op in Patients Undergoing Two-Level TLIF
Clinical Results Of Lumbar Fusion At 1 Year Follow-Up Three Levels
61.4
40.07
8.754.33
0
10
20
30
40
50
60
70
OswestryDisability Index
Visual AnalogScale
Pre-opPost-op
Mean Change From Pre-op to One-Year Post-op in Patients Undergoing One-Level TLIF
Patient Satisfaction RatesConvalescent Care
0%10%20%30%40%50%60%70%80%90%
100%
Room PainControl
Food NursingCare
Overall
1 Level2 Level3 Level
Conclusions
Improvement In V.A.S./O.D.I. and Minimal Complication Rates Indicate Lumbar Fusion At
One, Two, And Three Levels Can Be Safely Performed With Efficacy At An
A.S.C./Convalescent Center.
Lumbar Artificial Disc – F.D.A., I.D.E. Study
Time In O.R. (61 Patients) 100 MinutesTime In P.A.C.U. 83 MinutesTime In Convalescent 21 Hours
Peri-Operative Complications
Vascular Laceration = 1 Patient (1200cc)
Return To O.R. = 2 Patients = Replace Disc
Clinical Outcomes At 2 Year Follow-Up in F.D.A., I.D.E. Study
Statistical Improvement In V.A.S. / O.D.I.
Lumbar Artificial Disc Results Outside F.D.A./I.D.E. Study
Multi Level Patients
Single Level Patients
Outside Insurance Cost Analysis60% Savings Over Hospital Costs
Overall Conclusions
Spine Surgery Must Be CategorizedCervical Fusions/Cervical Artificial Discs/Lumbar Nerve Decompressions Can Be Performed Safely With Efficacy At An A.S.C.Lumbar Fusions/Artificial Disc Can Be Performed At An A.S.C./Convalescent UnitSignificant Cost Savings(60%) At An A.S.C. vs. A HospitalSpine Surgery Can Be A major Income GeneratorImplant Cost Contracts Are Important
Thank You!
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