Postoperative Care Following Outpatient Spine Surgery

  • Troy I. Mounts
  • Gil Tepper


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.


Outpatient Postoperative care Counseling Spine surgery 


  1. 1.
    Whippey A, Kostandoff G, Paul J, Ma J, Thabane L, Ma HK. Predictors of unanticipated admission following ambulatory surgery: a retrospective case-control study. Can J Anaesth. 2013;60(7):675–83.CrossRefGoogle Scholar
  2. 2.
    Lee MJ, Cizik AM, Hamilton D, Chapman JR. Predicting medical complications after spine surgery: a validated model using a prospective surgical registry. Spine J. 2014;14(2):291–9.CrossRefGoogle Scholar
  3. 3.
    Lee MJ, Hacquebord J, Varshney A, Cizik AM, Bransford RJ, Bellabarba C, Konodi MA, Chapman J. Risk factors for medical complication after lumbar spine surgery: a multivariate analysis of 767 patients. Spine (Phila Pa 1976). 2011;36(21):1801–6.CrossRefGoogle Scholar
  4. 4.
    Mathis MR, Naughton NN, Shanks AM, Freundlich RE, Pannucci CJ, Chu Y, Haus J, Morris M, Kheterpal S. Patient selection for day case-eligible surgery: identifying those at high risk for major complications. Anesthesiology. 2013;119(6):1310–21.CrossRefGoogle Scholar
  5. 5.
    Joshi GP, Ahmad S, Riad W, Eckert S, Chung F. Selection of obese patients undergoing ambulatory surgery: a systematic review of the literature. Anesth Analg. 2013;117(5):1082–91.CrossRefGoogle Scholar
  6. 6.
    McGirt MJ, Godil SS, Asher AL, Parker SL, Devin CJ. Quality analysis of anterior cervical discectomy and fusion in the outpatient versus inpatient setting: analysis of 7288 patients from the NSQIP database. Neurosurg Focus. 2015;39(6):E9.CrossRefGoogle Scholar
  7. 7.
    Pugely AJ, Martin CT, Gao Y, Mendoza-Lattes SA. Outpatient surgery reduces short-term complications in lumbar discectomy: an analysis of 4310 patients from the ACS-NSQIP database. Spine (Phila Pa 1976). 2013;38(3):264–71.CrossRefGoogle Scholar
  8. 8.
    Fu MC, Gruskay JA, Samuel AM, Sheha ED, Derman PB, Iyer S, Grauer JN, Albert TJ. Outpatient anterior cervical discectomy and fusion is associated with fewer short-term complications in one- and two-level cases: a propensity-adjusted analysis. Spine (Phila Pa 1976). 2017;42(14):1044–9.CrossRefGoogle Scholar
  9. 9.
    Adamson T, Godil SS, Mehrlich M, Mendenhall S, Asher AL, McGirt MJ. Anterior cervical discectomy and fusion in the outpatient ambulatory surgery setting compared with the inpatient hospital setting: analysis of 1000 consecutive cases. J Neurosurg Spine. 2016;24:878–84.CrossRefGoogle Scholar
  10. 10.
    Owens PL, Barrett ML, Raetzman S, Maggard-Gibbons M, Steiner CA. Surgical site infections following ambulatory surgery procedures. JAMA. 2014;311(7):709–16.CrossRefGoogle Scholar
  11. 11.
    Garringer SM, Sasso RC. Safety of anterior cervical discectomy and fusion performed as outpatient surgery. J Spinal Disord Tech. 2010;23(7):439–43.CrossRefGoogle Scholar
  12. 12.
    Sheperd CS, Young WF. Instrumented outpatient anterior cervical discectomy and fusion: is it safe? Int Surg. 2012;97:86–9.CrossRefGoogle Scholar
  13. 13.
    Woolf CJ, Chong MS. Preemptive analgesia—treating postoperative pain by preventing the establishment of central sensitization. Anesth Analg. 1993;77(2):362–79.CrossRefGoogle Scholar
  14. 14.
    Kim JC, Choi YS, Kim KN, Shim JK, Lee JY, Kwak YL. Effective dose of peri-operative oral pregabalin as an adjunct to multimodal analgesic regimen in lumbar spinal fusion surgery. Spine (Phila Pa 1976). 2011;36(6):428–33.CrossRefGoogle Scholar
  15. 15.
    Sawan H, Chen AF, Viscusi ER, Parvizi J, Hozack WJ. Pregabalin reduces opioid consumption and improves outcome in chronic pain patients undergoing total knee arthroplasty. Phys Sportsmed. 2014;42(2):10–8.CrossRefGoogle Scholar
  16. 16.
    Mathiesen O, Wetterslev J, Kontinen VK, Pommergaard HC, Nikolajsen L, Rosenberg J, Hansen MS, Hamunen K, Kjer JJ, Dahl JB, Scandinavian Postoperative Pain Alliance (ScaPAlli). Adverse effects of perioperative paracetamol, NSAIDs, glucocorticoids, gabapentinoids and their combinations: a topical review. Acta Anaesthesiol Scand. 2014;58(10):1182–98.CrossRefGoogle Scholar
  17. 17.
    Tiippana EM, Hamunen K, Kontinen VK, Kalso E. Do surgical patients benefit from perioperative gabapentin/pregabalin? A systematic review of efficacy and safety. Anesth Analg. 2007;104(6):1545–56, table of contents.CrossRefGoogle Scholar
  18. 18.
    Dahl JB, Nielsen RV, Wetterslev J, Nikolajsen L, Hamunen K, Kontinen VK, Hansen MS, Kjer JJ, Mathiesen O, Scandinavian Postoperative Pain Alliance (ScaPAlli). Post-operative analgesic effects of paracetamol, NSAIDs, glucocorticoids, gabapentinoids and their combinations: a topical review. Acta Anaesthesiol Scand. 2014;58(10):1165–81.CrossRefGoogle Scholar
  19. 19.
    Kurd MF, Kreitz T, Schroeder G, Vaccaro AR. The role of multimodal analgesia in spine surgery. J Am Acad Orthop Surg. 2017;25(4):260–8.CrossRefGoogle Scholar
  20. 20.
    Halawi MJ, Grant SA, Bolognesi MP. Multimodal analgesia for total joint arthroplasty. Orthopedics. 2015;38(7):e616–25.CrossRefGoogle Scholar
  21. 21.
    Devin CJ, McGirt MJ. Best evidence in multimodal pain management in spine surgery and means of assessing postoperative pain and functional outcomes. J Clin Neurosci. 2015 Jun;22(6):930–8.CrossRefGoogle Scholar
  22. 22.
    Starmer HM, Riley LH 3rd, Hillel AT, Akst LM, Best SR, Gourin CG. Dysphagia, short-term outcomes, and cost of care after anterior cervical disc surgery. Dysphagia. 2014;29:68–77.CrossRefGoogle Scholar
  23. 23.
    Trahan J, Abramova MV, Richter EO, Steck JC. Feasibility of anterior cervical discectomy and fusion as an outpatient procedure. World Neurosurg. 2011;75:145–8.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Troy I. Mounts
    • 1
  • Gil Tepper
    • 1
  1. 1.Department of OrthopaedicsMiracle Mile Medical CenterLos AngelesUSA

Personalised recommendations