Spine Surgery Experience at the Loveland Surgery Center Loveland, Colorado Kenneth A. Pettine, M.D., M.S.
<ul><li>I.D.E. Site  For Eight F.D.A. Spinal Implant Studies </li></ul><ul><li>Joint Commission Accredited </li></ul><ul><...
Spine Surgery Definitions <ul><li>Lumbar Spine Surgery – two broad categories </li></ul><ul><ul><li>Leg Pain Surgery   </l...
Equipment Requirements <ul><li>General Surgeon </li></ul><ul><li>Cell Saver </li></ul><ul><li>Implants </li></ul><ul><li>C...
Anterior Cervical Fusion (A.C.F) or Artificial Disc Replacement <ul><li>C-Arm </li></ul><ul><li>Implants </li></ul><ul><li...
Lumbar Spine Decompression <ul><li>Dural Tear Instruments </li></ul><ul><li>Cloward or Equivalent Table </li></ul><ul><li>...
Spine Implant Costs <ul><li>Facility Fee </li></ul><ul><ul><li>Case Rate For </li></ul></ul><ul><ul><ul><li>ACF- $6,500.00...
The Spine Journal The Spine Journal 7 (2007) 148-153 The safety of instrumented outpatient anterior cervical discectomy an...
Spine SPINE Volume 32, Number 10, pp 1135-1139 Outpatient Lumbar Spine Decompression in 233 Patients 65 Years of Age or Ol...
Spine Surgery At Ambulatory Surgery Center <ul><li>Anterior Cervical Fusions (One Level, Possible Two and Three) </li></ul...
Instrumented Spine Surgery 375 Patients (Every Instrumented Spine Surgery Analyzed, Between Spring 2003 And Spring 2006) <...
Results of Anterior Cervical Fusions (ACF)  (148 Patients) <ul><li>Time In OR </li></ul><ul><ul><li>1 Level : 81.72 Min. (...
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-...
Patient Satisfaction Rates One Level ACF <ul><li>Convalescent care room: 95%  (CCR) </li></ul><ul><li>Pain control: 98%  (...
Patient Satisfaction Rates Two Level ACF <ul><li>Convalescent care room: 99%  (CCR) </li></ul><ul><li>Pain control: 93%  (...
Conclusion Of A.C.F. Data <ul><li>Clinical Results of Improvement in V.A.S. and N.D.I. Are Statistically Significant. A.C....
Lumbar Fusion 146 Patients <ul><li>Time In O.R. </li></ul><ul><ul><li>1 Level : 157.51 Min. </li></ul></ul><ul><ul><li>2 L...
Lumbar Fusion 146 Patients <ul><li>Time In P.A.C.U. </li></ul><ul><ul><li>1 Level:  77.59 Min. </li></ul></ul><ul><ul><li>...
Lumbar Fusion  146 Patients <ul><li>Time In Convalescent Unit </li></ul><ul><ul><li>1 Level:  42.10 Hours </li></ul></ul><...
Peri-Operative Complications <ul><li>Return To O.R. To Drain Fluid = 1 Patient </li></ul><ul><li>No Nerve Injuries, Infect...
Clinical Results Of Lumbar Fusion At 1 Year Follow-Up One Level Mean Change From Pre-op to One-Year Post-op in Patients Un...
Clinical Results Of Lumbar Fusion At 1 Year Follow-Up Two Level Mean Change From Pre-op to One-Year Post-op in Patients Un...
Clinical Results Of Lumbar Fusion At 1 Year Follow-Up Three Levels Mean Change From Pre-op to One-Year Post-op in Patients...
Patient Satisfaction Rates Convalescent Care
Conclusions <ul><li>Improvement In V.A.S./O.D.I. and Minimal Complication Rates Indicate Lumbar Fusion At One, Two, And Th...
Lumbar Artificial Disc – F.D.A., I.D.E. Study <ul><li>Time In O.R. (61 Patients) 100 Minutes </li></ul><ul><li>Time In P.A...
Lumbar Artificial Disc Results Outside F.D.A./I.D.E. Study <ul><li>Multi Level Patients </li></ul><ul><li>Single Level Pat...
Overall Conclusions <ul><li>Spine Surgery Must Be Categorized </li></ul><ul><li>Cervical Fusions/Cervical Artificial Discs...
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Spine Surgery Experience at the Loveland Surgery Center

  1. 1. Spine Surgery Experience at the Loveland Surgery Center Loveland, Colorado Kenneth A. Pettine, M.D., M.S.
  2. 2. <ul><li>I.D.E. Site For Eight F.D.A. Spinal Implant Studies </li></ul><ul><li>Joint Commission Accredited </li></ul><ul><li>Spine Surgeons – 2 (3) </li></ul><ul><li>E.N.T. Surgeons –2 </li></ul><ul><li>Orthopedic Surgeons –2 </li></ul><ul><li>Pain Specialists –1 (2) </li></ul>Loveland Surgery Center
  3. 3. Spine Surgery Definitions <ul><li>Lumbar Spine Surgery – two broad categories </li></ul><ul><ul><li>Leg Pain Surgery </li></ul></ul><ul><ul><ul><li>Nerve Decompression for Stenosis (Older Patient) </li></ul></ul></ul><ul><ul><ul><li>Discectomy for Herniated Disc (Younger Patient) </li></ul></ul></ul><ul><ul><li>Back Pain Surgery </li></ul></ul><ul><ul><ul><li>Fusion: Pedicle Screws (Posterior Approach) </li></ul></ul></ul><ul><ul><ul><li>Artificial Disc (Anterior Approach) </li></ul></ul></ul><ul><li>Cervical Spine Surgery- </li></ul><ul><ul><li>Arm and/or Neck Pain –Anterior Cervical Fusion </li></ul></ul><ul><ul><li>Posterior Cervical Surgery is rare </li></ul></ul>
  4. 4. Equipment Requirements <ul><li>General Surgeon </li></ul><ul><li>Cell Saver </li></ul><ul><li>Implants </li></ul><ul><li>C-Arm </li></ul><ul><li>Cloward or Equivalent Table </li></ul><ul><li>C-Arm </li></ul><ul><li>Retractors/Kerisons </li></ul><ul><li>High Speed Burr </li></ul><ul><li>Implants –Screws/Rods/Cages </li></ul><ul><li>Bone Graft </li></ul><ul><li>Cell Saver </li></ul><ul><li>Dural Tear Instruments </li></ul>Posterior Lumbar Interbody Fusion (P.L.I.F.) Anterior Lumbar Artificial Discs/Fusion (A.L.I.F)
  5. 5. Anterior Cervical Fusion (A.C.F) or Artificial Disc Replacement <ul><li>C-Arm </li></ul><ul><li>Implants </li></ul><ul><li>Bone Graft </li></ul><ul><li>Specialized Retractors </li></ul><ul><li>High Speed Burr (Possible) </li></ul>
  6. 6. Lumbar Spine Decompression <ul><li>Dural Tear Instruments </li></ul><ul><li>Cloward or Equivalent Table </li></ul><ul><li>C-Arm </li></ul><ul><li>Retractors </li></ul><ul><li>Kerisons </li></ul><ul><li>No Implants </li></ul>
  7. 7. Spine Implant Costs <ul><li>Facility Fee </li></ul><ul><ul><li>Case Rate For </li></ul></ul><ul><ul><ul><li>ACF- $6,500.00 </li></ul></ul></ul><ul><ul><ul><li>PLIF- $8,500.00 </li></ul></ul></ul><ul><li>Implant Costs </li></ul><ul><ul><li>ACF </li></ul></ul><ul><ul><ul><li>1 Level - $4,500.00 </li></ul></ul></ul><ul><ul><ul><li>2 Level - $7,325.00 </li></ul></ul></ul><ul><ul><li>PLIF </li></ul></ul><ul><ul><ul><li>1 Level - $21,000.00 </li></ul></ul></ul><ul><ul><ul><li>2 Level - $32,000.00 </li></ul></ul></ul><ul><ul><ul><li>3 Level - $44,200.00 </li></ul></ul></ul>
  8. 8. The Spine Journal The 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.
  9. 9. Spine SPINE 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.
  10. 10. Spine Surgery At Ambulatory Surgery Center <ul><li>Anterior Cervical Fusions (One Level, Possible Two and Three) </li></ul><ul><li>Lumbar Nerve Decompressions </li></ul><ul><li>Discectomies </li></ul>Spine Surgery at Ambulatory Surgery Center with Convalescent License <ul><li>Lumbar Fusions Anterior/Posterior </li></ul><ul><li>Lumbar Artificial Disc Replacement </li></ul>
  11. 11. Instrumented Spine Surgery 375 Patients (Every Instrumented Spine Surgery Analyzed, Between Spring 2003 And Spring 2006) <ul><li>Anterior Cervical Fusion </li></ul><ul><ul><li>1 Level : 87 Patients </li></ul></ul><ul><ul><li>2 Level : 63 Patients </li></ul></ul><ul><li>Posterior Lumbar Fusion </li></ul><ul><ul><li>1 Level : 84 Patients </li></ul></ul><ul><ul><li>2 Level : 50 Patients </li></ul></ul><ul><ul><li>3 Level : 12 Patients </li></ul></ul><ul><li>Lumbar Artificial Disc : 61 Patients </li></ul>
  12. 12. Results of Anterior Cervical Fusions (ACF) (148 Patients) <ul><li>Time In OR </li></ul><ul><ul><li>1 Level : 81.72 Min. (87 Patients) </li></ul></ul><ul><ul><li>2 Level : 84.43 Min. (61 Patients) </li></ul></ul><ul><li>Time In PACU </li></ul><ul><ul><li>1 Level : 92.54 Min. </li></ul></ul><ul><ul><li>2 Level : 80.80 Min. </li></ul></ul><ul><li>Convalescent Care </li></ul><ul><ul><li>1 Level : 20.68 Hours </li></ul></ul><ul><ul><li>2 Level : 20.33 Hours </li></ul></ul><ul><li>Peri-Operative Complications = None </li></ul><ul><li>Unplanned Transfers = None </li></ul>
  13. 13. 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
  14. 14. Patient Satisfaction Rates One Level ACF <ul><li>Convalescent care room: 95% (CCR) </li></ul><ul><li>Pain control: 98% (PC) </li></ul><ul><li>Food in the convalescent care unit: 93% (Food) </li></ul><ul><li>Nursing care: 97% (NC) </li></ul><ul><li>Overall experience: 95% (OE) </li></ul>
  15. 15. Patient Satisfaction Rates Two Level ACF <ul><li>Convalescent care room: 99% (CCR) </li></ul><ul><li>Pain control: 93% (PC) </li></ul><ul><li>Food in the convalescent care unit: 93% (Food) </li></ul><ul><li>Nursing care: 99% (NC) </li></ul><ul><li>Overall experience: 96% (OE) </li></ul>
  16. 16. Conclusion Of A.C.F. Data <ul><li>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. </li></ul>
  17. 17. Lumbar Fusion 146 Patients <ul><li>Time In O.R. </li></ul><ul><ul><li>1 Level : 157.51 Min. </li></ul></ul><ul><ul><li>2 Level : 186.09 Min. </li></ul></ul><ul><ul><li>3 Level : 213 Min. </li></ul></ul>
  18. 18. Lumbar Fusion 146 Patients <ul><li>Time In P.A.C.U. </li></ul><ul><ul><li>1 Level: 77.59 Min. </li></ul></ul><ul><ul><li>2 Level: 85.79 Min. </li></ul></ul><ul><ul><li>3 Level: 91.07 Min. </li></ul></ul>
  19. 19. Lumbar Fusion 146 Patients <ul><li>Time In Convalescent Unit </li></ul><ul><ul><li>1 Level: 42.10 Hours </li></ul></ul><ul><ul><li>2 Level: 50.07 Hours </li></ul></ul><ul><ul><li>3 Level: 55.11 Hours </li></ul></ul>
  20. 20. Peri-Operative Complications <ul><li>Return To O.R. To Drain Fluid = 1 Patient </li></ul><ul><li>No Nerve Injuries, Infections, Vascular Problems </li></ul><ul><li>Unplanned Transfers To Hosp./Rehab </li></ul><ul><ul><li>Rehab Unit = 2 Patients </li></ul></ul><ul><ul><li>Hospital = 1 Patient, Oxycontin Reaction Causing Excessive Sedation </li></ul></ul>
  21. 21. Clinical Results Of Lumbar Fusion At 1 Year Follow-Up One Level Mean Change From Pre-op to One-Year Post-op in Patients Undergoing Third-Level PLIF
  22. 22. Clinical Results Of Lumbar Fusion At 1 Year Follow-Up Two Level Mean Change From Pre-op to One-Year Post-op in Patients Undergoing Two-Level TLIF
  23. 23. Clinical Results Of Lumbar Fusion At 1 Year Follow-Up Three Levels Mean Change From Pre-op to One-Year Post-op in Patients Undergoing One-Level TLIF
  24. 24. Patient Satisfaction Rates Convalescent Care
  25. 25. Conclusions <ul><li>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. </li></ul>
  26. 26. Lumbar Artificial Disc – F.D.A., I.D.E. Study <ul><li>Time In O.R. (61 Patients) 100 Minutes </li></ul><ul><li>Time In P.A.C.U. 83 Minutes </li></ul><ul><li>Time In Convalescent 21 Hours </li></ul>Peri-Operative Complications <ul><li>Vascular Laceration = 1 Patient (1200cc) </li></ul><ul><li>Return To O.R. = 2 Patients = Replace Disc </li></ul>Clinical Outcomes At 2 Year Follow-Up in F.D.A., I.D.E. Study <ul><li>Statistical Improvement In V.A.S. / O.D.I. </li></ul>
  27. 27. Lumbar Artificial Disc Results Outside F.D.A./I.D.E. Study <ul><li>Multi Level Patients </li></ul><ul><li>Single Level Patients </li></ul>Outside Insurance Cost Analysis <ul><li>60% Savings Over Hospital Costs </li></ul>
  28. 28. Overall Conclusions <ul><li>Spine Surgery Must Be Categorized </li></ul><ul><li>Cervical Fusions/Cervical Artificial Discs/Lumbar Nerve Decompressions Can Be Performed Safely With Efficacy At An A.S.C. </li></ul><ul><li>Lumbar Fusions/Artificial Disc Can Be Performed At An A.S.C./Convalescent Unit </li></ul><ul><li>Significant Cost Savings(60%) At An A.S.C. vs. A Hospital </li></ul><ul><li>Spine Surgery Can Be A major Income Generator </li></ul><ul><li>Implant Cost Contracts Are Important </li></ul>
  29. 29. Thank You!

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