MUNSTER — The surgeon hammered into the patient's bone before extracting stem cells with a large syringe. He then handed it off to an assistant, as classic rock played on a nearby Bose speaker.
Thirty minutes later, another surgeon stitched up the man's back. The patient now had a new spinal disc, injected with those same stem cells to help it fuse to the bone. The doctor, dressed in blue scrubs, noted the lack of red in the chilly operating room.
"If you're going to get your blood drawn, you'd have more blood loss than this lumbar fusion," said Dr. Nitin Khanna, a Munster spine surgeon who has the relaxed demeanor that seems a prequisite for the field.
Thanks to advances in medical technology and pain management, more and more surgeries that used to require hospital stays are now being performed on an outpatient basis, allowing patients to recover at home, cutting down their risk of complications and, in general, costing them less money.
"The main driver is to give the patient a better experience," said Dr. Dwight Tyndall, a spine surgeon and Khanna's partner at Munster-based Orthopaedic Specialists of Northwest Indiana.
Hospitals also see shift
Even many hospitals now do the majority of their procedures on an outpatient basis. At its campuses in Crown Point, Dyer, Hammond and Munster, Franciscan Alliance went from doing 8,856 inpatient surgeries in 2010 to 6,854 last year, while its outpatient volume increased from 16,123 in 2010 to 20,944 in 2015.
For Community Hospital in Munster, 60 percent to 70 percent of its surgeries are now ambulatory.
"You just have to make sure it's the right procedure and you have the right patient as well," said Dr. Richard Berkowitz, medical director of surgery at Community Hospital. "Some patients are very healthy and great candidates to go home the same day. But there's always going to be a subset of patients who have comorbidities and require inpatient surgeries."
Many hospital groups also now have separate ambulatory surgery centers. "In the hospital there are sick patients. Our waiting room is private. Every patient who comes in there is a surgical patient," said Darlene McCrammer, director of outpatient surgery at Porter Health Care System's Chandana Surgery Center in Valparaiso.
Dr. Craig Della Valle, a surgeon with Midwest Orthopaedics at Rush in Munster, says he now does about a third of his hip and knee replacements in outpatient settings. "It's not appropriate for everybody. But for younger or healthier patients with a good support network, it's a good, convenient way to do it," he said.
Faster surgeries, recoveries
Recovery times also are generally faster with less invasive procedures. Lori Fields, a 57-year-old police administrator from Lansing, recently had outpatient spine surgery performed by Khanna. She was home within a day, returning to work three weeks later.
"I am back at the gym, working out," she said a few months after the procedure. "I can't believe what a difference it's made. I don't have to take an ibuprofen before I go just to take the edge off the pain to get moving."
Fields said her brother underwent the same surgery about a decade earlier. He stayed in the hospital for eight days and didn't go back to work for nearly six months.
On the recent day at the Center for Minimally Invasive Surgery, after he and Tyndall implanted screws into the patient's spine from a different site, Khanna finished sewing the man up for the second time, at the three-hour mark. He noted that a traditional lumbar fusion generally takes more than twice than time. He and Tyndall fist-bumped.
Khanna noted that while less than 5 percent of these surgeries are being done in the outpatient setting now, he expects that number to be 80 percent in five years.
"Patients are going to start demanding these new technologies," Tyndall said, "and surgeons are going to have to switch over because that's what patients want."