We are used to the industry hype cycle. Every year, a new technique promises to revolutionize spine care, and every year, we go back to the O.R. and do mostly the same things. But the migration of the 360° lumbar fusion to the outpatient setting feels different. It feels inevitable. Advances in surgical techniques, anesthesia, and postoperative care have made it possible for many patients to safely undergo spine surgery and return home the same day.
The skepticism is valid. This is a beast of a surgery. Accessing the spine from the front and the back. Anterior and posterior. Traditionally, that buys you a ticket to a hospital bed for three or four days. You need pain pumps. You need eyes on the patient. Patients typically need to arrive several hours before the scheduled surgery to complete necessary pre-operative procedures.
So when a new analysis from DISC Surgery Center claims 203 consecutive patients were discharged within 23 hours with zero hospital transfers, zero transfusions, and zero readmissions, we have to stop and ask: How? Patients are carefully monitored post-procedure and only discharged once they’re stable, alert, and able to move with minimal assistance.
Is it luck? Or is it engineering?
Dr. Steven J. Girdler’s study covers cases from 2018 to 2024. That’s a decent sample size. The average operating time was a tight 167 minutes. That is efficient. But the “magic” here isn’t just speed. It’s context. Early mobilization, including getting patients out of bed and walking soon after surgery, has become a standard part of outpatient spine care.
Dr. Rojeh Melikian, a surgeon in the trenches at DISC, puts the gravity of this shift into perspective.
“A 360° spinal fusion is one of the most complex spinal fusions because it involves accessing both the front (anterior) and back (posterior) parts of your spine,” Melikian says. “A decade ago, a complex, multistage surgery like the 360° fusion would have been done at the hospital with a lengthier stay.”
Now? They are home in less than a day. Melikian notes the upside isn’t just avoiding bad hospital food. It’s avoiding “hospital baggage”; infections, clots, the lethargy of the inpatient ward.
We need to look at the menu. It isn’t just about big fusions. The shift to the ambulatory surgery center covers the whole spectrum. You have your lumbar decompression. You have your anterior cervical discectomy. Even complex cervical spine work is moving out of the main building. Common outpatient spine procedures include anterior cervical discectomy and fusion (ACDF), microlumbar discectomy (MLD), lumbar laminectomy, posterior cervical foraminotomy, and cervical disc arthroplasty. But here is the thing about outpatient spine surgery. The risks change. They don’t disappear. They just look different.
In the inpatient setting, you are worried about hospital acquired infections. Superbugs. That stuff is scary. In an ambulatory setting, the enemy is often much more mundane. Postoperative urinary retention. Seriously. If you can’t pee, you aren’t going home. It sounds minor until it happens to you. Benign prostatic hyperplasia becomes a major red flag during the screening process. Postoperative urinary retention can occur after outpatient spine surgery, particularly in patients with preexisting conditions.
And let’s be real about complication rates. The data shows that outpatient spine procedures are safe for appropriately selected patients. But you have to watch for medical complications like hematomas. Or just bad pain control. Clinical outcomes in an outpatient cohort rely heavily on speed and precision.
The surgical techniques have to be flawless. There is no ICU to fix a sloppy mistake. Outcome measures compared between settings show us that ambulatory procedures hold up. But only if the surgeon is good. Really good.
Let’s talk about money. Because that is what moves the needle for the payers.
Inpatient fusion is a line-item budget killer. Over $14 billion in hospital costs back in 2018. Moving these 360° fusions to an ASC doesn’t just shave costs. It slashes them. We are looking at 50% to 70% savings per episode.
If we migrated half of the eligible cases, we’d free up over $1 billion annually. That is the kind of math that gets insurance executives to return your calls.
James H. Becker, CEO of TriasMD, told us that the payers aren’t just passively allowing this. They are pushing for it.
“Insurance companies are actively driving the site-of-service shift from hospitals to ASCs,” Becker says. “Our safety record and proven outcomes make us a natural partner.”
Becker also highlights a leverage point people often miss. Volume. By focusing strictly on spine and ortho, they aren’t buying supplies like a generalist.
“We are also often able to negotiate improved pricing on the same high-quality medical devices and supplies,” Becker notes. “In short, we’re performing more of these procedures than most hospitals.”
Here is the friction point. If it’s cheaper and better, why isn’t every ASC doing it?
Because they can’t.
The press release talks about a “four-pillar model”; teams, protocols, facilities, education. It sounds like standard corporate messaging until you dig into the “So What?” with the people running it.
Dr. Melikian insists you can’t pick a favorite child. “There is no way to single out just one element,” he says. It’s the nursing staff, the education, the minimally invasive skill. All of it.
But Becker? He knows where the bodies are buried. He points to the invisible infrastructure as the real competitive moat.
“If I’m being strategic about competitive advantage, it’s our customized clinical protocols,” Becker admits. “World-class surgeons and excellent facilities exist throughout healthcare. But our engineered approach to patient selection, surgical optimization, and pre/post-operative management—that’s what’s difficult to replicate.”
Read that again. Patient selection.
That zero-readmission stat? It exists because they say “no.” Dr. Melikian was blunt about who gets to play.
“Patients who are not good candidates... tend to be those who are medically complex,” Melikian explains. “Heart failure, chronic lung disease, or on dialysis. In these cases... hospitalization is recommended.”
This is the “secret sauce.” You filter out the variables you can’t control. A standard community ASC that tries to shoehorn a sick patient into this 23-hour window to capture the revenue is going to have a bad outcome. Period.
Pain hurts. Obviously. But in inpatient surgery, things are ran more aggressively. You can’t do that in same day surgery. They need to walk to the car. This is where multimodal pain management protocols come in. It’s a fancy way of saying we attack pain from five different directions at once so we don’t have to knock you out completely.
The anesthesia team is actually the MVP here. Postoperative nausea is the number one reason discharge gets delayed. If you are throwing up, you are staying over. So they manage that aggressively. And adequate pain control doesn’t mean zero pain. It means manageable pain.
We also have to talk about the cuts. Minimally invasive spine surgery isn’t just a buzzword. It is a requirement. Techniques like lateral lumbar interbody fusion or anterior lumbar interbody fusion allow surgeons to avoid cutting through the big muscles in the back. Less muscle damage means less pain. Which means you might actually want to do your physical therapy. Minimally invasive spine surgery (MISS) techniques have revolutionized spine procedures, offering benefits such as smaller incisions and reduced blood loss.
Minimally invasive procedures are the only reason this works. If you did a traditional open posterior lumbar fusion with a huge incision, nobody is going home in 23 hours. No way. Spinal procedures have evolved. Healthcare providers in the outpatient hospital setting or an ASC have to evolve with them.
So, where is this going?
The hospital isn’t dead. But it is changing. It’s becoming the destination for the sickest 10% of the population. The “medically complex” cases Melikian mentioned. Patients with complex spinal issues may require traditional inpatient surgery instead of same-day spine surgery.
For everyone else? The future is decentralized.
Becker warns that scaling this isn’t as simple as building more rooms.
“Scalability doesn’t mean any ASC can start doing this tomorrow,” Becker cautions. “Most surgery centers aren’t structured for this level of complexity. You need purpose-built infrastructure... The centers that succeed will be those willing to specialize at the level DISC has.”
This isn’t a generic shift. It’s a bifurcation. High-performance centers take the “routine” complex cases. Hospitals take the trauma and the comorbidities.
And the list of “routine” surgeries is growing. Dr. Melikian sees the next wave already forming.
“We have already begun to see the migration of tumor surgeries... to outpatient facilities,” Melikian says.
The data from this study proves the 23-hour 360° fusion is safe. But only if you build the machine to support it. For the rest of the market, it’s a warning: Adapt your infrastructure, or get left with the cases nobody else wants.
The perceived cost savings are real. But the patient experience is the real kicker. We are seeing a massive shift in outpatient cervical and lumbar surgery. The risk factors are being managed better than ever. Spine surgeons are getting more comfortable with the ambulatory surgical center environment. (And let’s be honest, everyone prefers sleeping in their own bed.)
The surgical setting matters less than the system built around it. Whether it is spinal stenosis or a recurrent disc herniation, the future is clear. Inpatient procedures for routine spine issues are fading. The ambulatory surgery centers are winning. Bottom line? If you fit the criteria, get out of the hospital. The transition to outpatient spine surgery is fueled by financial concerns of escalating healthcare costs, making it a cost-effective solution for patients and payers.