A Patients' Guide to Outpatient Surgery

Spine Care at an Ambulatory Surgery Center (ASC): Your Questions Answered

Hospitals aren’t the only places where you can have spine surgery. As medical advancements have led the spinal field toward minimally invasive technologies, more back and neck procedures can now be safely performed at an ambulatory surgery center—or ASC.

What Is an Ambulatory Surgery Center (ASC)?

An ambulatory surgery center (or ASC) is an outpatient care facility that offers surgical procedures, including many types of spine surgery. ASCs provide same-day surgical care, offering patients an alternative to the inpatient hospital setting.

Some facilities are multi-specialty ASCs, which means they offer a range of medical services from different specialties (eg, a single ASC may offer orthopaedic, podiatry, and pain management services). Other ASCs are single-specialty facilities, which means they focus on 1 medical specialty (an outpatient spine surgery center is an example of a single-specialty ASC).
Woman in a hospital bed, in an outpatient setting.ASCs provide same-day surgical care, offering patients an alternative to the inpatient hospital setting.

How Does an ASC Maintain Quality?

ASCs and hospital outpatient departments operate in the same fashion, and ASCs follow strict laws, procedures, and standards of care to protect patient safety.

All ASCs must:

  • Maintain a clean environment and have an infection prevention plan in place.
  • Regularly assess their facility’s care quality and report patient outcomes.
  • Ensure that a nurse trained in performing emergency services (eg, CPR) is available at the facility when patients are in the building.
  • Have a transfer agreement with a local hospital and have a plan for transferring patients to that hospital in an emergency.1

Most ASCs are also Medicare certified, which means they must follow additional protocols to maintain that credential. These protocols include:

  • Maintaining accurate patient documentation (ie, medical records)
  • Physician-led safety evaluations of each patient before and after surgery1

What Types of Spine Surgery Are Performed in an ASC Setting?

The types of spine procedures offered in ASCs is growing substantially. Between 2003 and 2014, the proportion of lumbar discectomies performed in ASCs spiked from 0.7% to 10.6%.2

Where once only simple decompression surgeries were performed in an ASC, now more complex fusions are being done in this setting.

The list below includes some common procedures offered at ASCs:*

*Note: This is not an exhaustive list of spine procedures offered at ASCs. As spine surgery technology evolves, more types of surgery may be performed in this setting that are not listed here.

What Are the Benefits of Having Spine Surgery in an ASC?

ASCs boast a range of benefits for patients, including:

  • Providing care in a convenient, comfortable setting without sacrificing quality.
  • Using minimally invasive techniques that allow for a speedier procedure and recovery.
  • Lower patient costs (minimal or no overnight stays means a lower bill)
  • Strict infection control (more than 50% of ASCs in the United States have a 0% infection rate)3

You may further explore the merits of spine care in an ASC in What Are the Benefits of Spine Surgery Performed at an Ambulatory Surgery Center?

Despite These Benefits, Should Some Patients Still Have Spine Surgery in a Hospital?

Though technology is making it easier for spine surgery to be performed safely and effectively in an ASC, some complex spine surgical procedures (eg, to treat severe spinal deformity) are best performed in a hospital inpatient setting.

Patients who have a complex heart condition or other chronic disease may also be advised to have their spine procedure in a hospital.

As you discuss the possibility of spine surgery with your doctor, ask whether you are a good candidate for surgery in an outpatient ASC setting. Your doctor will explain whether the benefits outweigh the potential risks.

What Questions Should I Ask Before Having Spine Surgery at an ASC?

Making sure you fully understand your treatment, including the benefits and drawbacks of where you have your spine surgery, is important. The more you know about your diagnosis and treatment, the more involved you’ll be in your care decisions. Research shows that patients who are active participants in their health care are more likely to have better outcomes.3,4

In addition to these general questions to ask before spine surgery, the following are good questions to pose if the surgical site is an ASC:

  • How often has this procedure been performed in this ASC?
  • How often has the surgeon performed it in this setting?
  • How will my pain be treated during and after surgery?
  • What is the cost of my procedure?
  • Does this facility accept my medical insurance?
  • What are the credentials of this ASC? Is it accredited? Is it licensed or certified by the state? Is it Medicare certified?
  • Does this ASC associated have a transfer agreement with a nearby hospital?
  • Is my spine surgeon board certified?
  • In the event of a medical emergency, will staff be available to perform life-saving duties (eg, CPR)?
  • Who should I call if I have problems or questions during my spine surgery recovery?

Where Can I Learn More About Spine Care at Ambulatory Surgery Centers?

Spine care is rapidly changing—gone are the days where a hospital was the only place to have back or neck surgery. If you are planning to have your spine surgery performed at an ambulatory surgery center (ASC), it’s important you understand what that experience will be. These resources will help connect you to more information:

Updated on: 08/30/18
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Spine Surgery Risks and Potential Complications
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Spine Surgery Risks and Potential Complications

Complications of spine surgery to treat neck or back pain are often similar to other operations, except spinal surgery may involve greater risk depending on how it is performed (open or minimally invasive) and if spinal instrumentation and fusion are involved.
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