Spine Surgery in an Ambulatory Setting: What Can Be Done Safely?

T hefirst ambulatory surgery center was established in 1970 in Phoenix, Arizona by two surgeons with a vision of providing more convenient surgical services to their community. Twelve years later, Medicare approved the first payments to ambulatory surgery centers, sparking an era of substantial growth. By 1988, there were 1000 ambulatory surgery centers in the United States, and today more than 23 million procedures are performed yearly at 5300 ambulatory surgery centers. Because ambulatory surgery centers are delivering health care to patients, they require accreditation similar to traditional hospitals; however, while they can be accredited by The Joint Commission (http://www.jointcommission.org/) or the Healthcare Facilities Accreditation Program (HFAP) (http://www.hfap.org/) as can traditional hospitals, they also may be accredited by ambulatory surgery center-specific firms such as the American Association for Accreditation of Ambulatory Surgery Facilities (AAAASF) (http://www.aaaasf.org/) or the Accreditation Association for Ambulatory Health Care (AAAHC) (http://www.aaahc.org/). Additionally, all ambulatory surgery centers are required to have a hospital transportation plan in case a medical need arises that exceeds the capabilities of the ambulatory surgery center.