Outpatient Surgery Magazine

Special Outpatient Surgery Edition - Orthopedics - August 2018

Outpatient Surgery Magazine, providing current information on Surgical Services, Surgical Facility Administration, Outpatient Surgery News and Trends, OR Excellence and more.

Issue link: http://outpatientsurgery.uberflip.com/i/1012667

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Page 3 of 86

The Changing Landscape of Orthopedics With major shifts in the business and the practice of joint surgery come new challenges and opportunities. A late-afternoon hip revision add-on is a cruel way to end a busy surgeon's busy day, but it struck me after I fin- ished that case that revision sur- gery is symbolic of orthopedics today. Let's put aside for a moment that revision arthroplasty is a technically challenging sur- gery to perform — I can do 5 pri- mary hip replacements in the 4 hours it takes to do a single hip revision! — and that the reim- bursement is paltry. Instead, let's focus on what the increase in joint revisions says about the state of our specialty. • Revision burden. First, it tells us that patients are outliving their original joint implants, which for most patients last 10 to 20 years. We can expect a steady stream of revisions (the so-called "revision burden"), not just because more and more people are undergoing joint replacements, but because the revision rate for hip and knee replacement patients is 6% after 5 years and 12% after 10 years, studies show. Keep in mind that revi- 4 • O U T PA T I E N T S U R G E R Y M A G A Z I N E • A U G U S T 2 0 1 8 On Point P. Maxwell Courtney, MD • ONE OVERNIGHT Researchers say next-day, rather than same-day, discharge for some Medicare patients who undergo joint replacement represents the "sweet spot" for minimal complications.

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