The role of ambulatory surgical centers in current neurosurgical practice

Background: The recent focus on improving quality and reducing cost within the US healthcare system has increased care being performed in the outpatient setting. The impact on neurosurgeons’ practice patterns has not yet been fully elucidated. In addition, how this transition may affect neurosurgery resident training is unclear. To better understand these issues, we surveyed neurosurgeons. Methods: A 13-question survey was sent to Council of State Neurosurgical Societies email subscribers. The survey focused on training or practice level, location, practice setting, ambulatory surgical center (ASC) utilization, and types of procedures performed at ASCs. Responses were tabulated. Statistical analysis was performed. Results: Among 11,091 subscribers, 101 responses (0.9%) were recorded. Most of the respondents (57.4%) utilized an ASC in their practice. The commonly performed procedures were microdiscectomy (98.1%), hemilaminectomy (94.2%), battery changes (87.5%), single-level anterior cervical discectomy and fusion (84.6%), single-level lumbar or thoracic laminectomy (80.8%), and peripheral nerve decompression (66.7%). Cranial procedures were seldom performed. Other device-related procedures were common and included vagal nerve stimulation (32.5%), spinal cord stimulation (67.5%), baclofen pump placement (25%), and baclofen pump replacement (27.5%). Only 17.1% of respondents who worked in academia taught residents in an ASC. Conclusion: According to our survey results, most neurosurgeons have incorporated ASCs into their practices in some capacity and most frequently for simple spine procedures, device-related procedures, and peripheral nerve decompression. The limited resident involvement in procedures in the ASC setting, even among attending academic neurosurgeons, suggests an increased need for ASC incorporation in residency training.