Postoperative Care Following Outpatient Spine Surgery

The success of outpatient spine surgery (OPSS) relies on a team-spirited patient-centric approach, and informed cooperation has to take place between the patient, the surgeon, the extended healthcare team, and the surgical facility (ambulatory surgery center (ASC) or SPD) throughout the process. As the time spent under direct observation is considerably shorter in the outpatient setting, the postoperative care plan needs to be well documented and clearly communicated to the patient and their respective caregiver. In general, the establishment and further refinement of postoperative management should be broken into phases: early facility phase of 2–24 hours, a variable immediate post-discharge home phase, and a standard subacute phase similar to that after inpatient surgery. All three phases depend upon factors such as patient selection, preoperative counseling and expectation management, pre- and postsurgical analgesia, rehabilitation protocols, and patient education. With its implementation, surgeons must be aware of the various unique aspects of OPSS that can at times increase the surgical risk profile relative to inpatient surgery. The success of the outpatient track and its philosophy depend on quality patient education regarding the risks and benefits. This demands considerable coaching and management of patient and family expectations, the development of a well-prepared home support structure, and an appropriate proactive “participator” state of mind among all. The vulnerability and possible helpless attitude associated with surgery in general are potentially amplified at the suggestion of outpatient surgery and can be mitigated by a well-supported and well-educated team approach by all involved.