By David Moody, RN Administrator, Knightsbridge Surgery Center Minimally invasive spine, like many specialties, is migrating to the outpatient arena. Although adding the procedure to our facility required careful planning, achieving financial and clinical success was easier than we’d ever imagined. While outpatient spine procedures continue to gain greater acceptance in facilities around the country, my center was one of the first in the Columbus, Ohio, area to embrace the concept. Our two neurosurgeons championed the cause. Their initiative brought spine surgery to our center, and a measured approach made it work. Initial instrument purchases can be significant and driven by surgeon preference. I met with our surgeons, developed a list of the instrumentation they requested and worked with vendors to obtain the sets. One vendor provided a demo retractor tray, enabling surgeons to pick and choose the retractors that worked best.We performed and were reimbursed for procedures a few months before making final instrumentation purchases, a scenario that made the $125,000 instrument investment easier to swallow. When considering new technology, ask yourself the following questions. How much will it cost? Can it be done safely in an outpatient setting? Will contracted third-party payers reimburse for the surgery? I recently explored these issues when our surgeons considered replacing anterior laminectomy with a lateral approach. The company selling the required instrumentation provided a cadaver lab to train our surgeons, who responded favorably to the technical aspects of the lateral approach. I told the vendor that the cost of the instrumentation was a major barrier to our adding the procedure. The vendor responded with a creative solution, offering to roll the cost of the instrumentation into the implant fee, therefore passing the cost of the technology to the end user. I jumped at the chance to add the new procedure. If all goes according to schedule, our surgeons will be employing the lateral approach within the next few months. Minimally invasive approaches have dramatically improved recovery times, but we still expected to keep our spine patients in PACU into the early evening, and possibly overnight. In fact, patients recover quickly and typically leave the facility within a few hours post-op. The surgeons have embraced the system and help make timely discharges possible by selecting healthy patients for surgery. They have also decided to focus on anterior cervical fusions, single level laminectomies and minor, soft tissue procedures.