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My personal experience with spinal surgery
By Kay Ball, RN, MSA, CNOR, FAAN
Lewis Center, OH
Even though I'm a perioperative nurse, my anticipation and anxiety grew last May as I walked into the DISC (Diagnostic & Interventional Spinal Care) in Marina del Rey, CA, for a posterior stabilization with instrumentation procedure of my lower back (L4-5). Knowing that the surgery I was having usually requires a hospital stay, I was eager to experience this innovative technique.
I would attribute the success of my surgical procedure to three reasons: A pioneering technique, an adept surgeon along with a proficient team, and an ambulatory surgery center geared toward major procedures performed in an outpatient environment.
The pioneering technique involved a neurosurgeon, a microscope, revolutionary instruments, and new implantable devices. The entire procedure was performed using a microscope, which is a technique not always accepted or practiced by neurosurgeons today. The instrumentation was designed for microscopic use so that delicate tissue can be manipulated and positioned. Pedicle screws can be inserted in those sometime hard-to-reach areas. The new devices included a flexible rod system built to maintain movement in the spine — a logical goal so often forgotten by surgeons when dealing with the spine.
The second factor to the success equation was the expertise of the surgical team and the neurosurgeon, Robert Bray, MD, who has spent his career studying and developing surgical instrumentation and spinal surgery techniques that lead to positive outcomes. He has the ability to communicate complex information about spinal surgery outcomes and methods to patients while helping to allay anxiety about the upcoming surgery.
The surgical team, from the receptionist who greeted me to the registered nurse who discharged me, complemented and defined the ultimate teamwork required with this type of procedure. In fact, when I questioned the team members as to why they worked at the DISC, the answers were in unison: They all valued the teamwork approach with everyone working toward the same goals and, of course, being able to work with Bray and his colleagues.
The anesthesiologist played an extremely important role to ensure that the anesthetics used were individualized to my needs, especially since I usually experience severe nausea after anesthesia. The perioperative circulating nurse was eager to describe exactly what was going to happen and answer any questions I had. As she walked me into the surgery suite, her positive attitude along with her years of experience provided a lot of comfort during this very vulnerable point of my surgical experience. The little things that mean so much to a patient were obvious, such as the use of the warmer on the surgical table, how they would protect my eyes when I was positioned in the prone position, and the introductions to the other surgical team members. Another surgeon who was going to help Bray even removed his mask temporarily so I could see his face when he was introduced to me.
Keeping the LOS to less than 24 hours
The third part of the success triangle involved the new ambulatory surgery concept geared toward major procedures performed in an outpatient environment.
Most ambulatory surgery centers today are based on high-volume and quick surgeries, such as cataract extractions, hernia repairs, or tonsillectomies. Move them in, move them out. But this center was founded on the concept of being able to convert a relatively major spinal procedure to ambulatory status. This is only possible with a setting that provides safe care throughout the surgical experience.
Many outpatient facilities are not set up to provide this type of service, if needed. If provided, one RN to each patient is a crucial ratio so that every patient involved with a 23-hour stay can receive individualized and skilled nursing care.
Not requiring hospitalization is a critical concern today to prevent hospital-acquired infections and to keep the patient costs low. Bray decided that a 23-hour stay would be appropriate after my surgery, which means that one-on-one nursing care was provided for me throughout the night by an experienced RN proficient in PACU and ICU nursing. Since I was from out of town, the surgeon recommended I stay at a hotel across the parking lot from the surgery center. After I was released from the center, the doctor visited me that night at the hotel, and the nurse visited the next day. I returned to the center the following day to see the doctor.
My entire surgical experience was quite memorable and remarkable. Having worked in health care all of my life and being very critical of how patients are treated during surgery, I was very pleased with the care I received. Bray and his surgical team know the secret to successful outpatient spinal surgeries, and the result is a groundbreaking surgery center for spinal procedures.