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OS_1310_part2_Layout 1 10/7/13 10:25 AM Page 57 ADVERTORIAL Total Joints at a Freestanding ASC? Why Not? It's time to move these procedures to an outpatient setting, says this surgeon. Chris McClellan, DO, Altoona, Pa. Last January, our team here at breakthrough pain. The continuous Advanced Center for Surgery nerve block lasts for 2 to 3 days, by looked at the 500 or so total knees which time the most intense pain and hips I perform each year and has subsided. asked ourselves, "Why aren't we • It's early, but so far there've been doing more of these outpatient, in no significant complications. One our ASC?" We couldn't find a good patient experienced PONV. But reason, and so we began. Now we've had zero post-op infections we've done 50 of them. and zero DVT. Being out of the Some readers may find this hospital helps with the former, and shocking. Total joints as an the aggressive PT helps with the outpatient ASC procedure? But latter. take a look at the big picture, and • Patient satisfaction is sky-high. No see if you don't agree. patient has said "I wish I had my A decade or so ago, total knees procedure done in the hospital. " involved 8-inch incisions, large The more common response is, incisions of the quadriceps muscle "I would definitely do this again and tendon, patellar eversion and and refer my friends. " The author at work: A total knee case significant blood loss. Most There are important financial at the Advanced Center for Surgery. patients got general anesthesia implications, too. At our ASC, we can only, and suffered severe pain and do total joints for about a third of the cost of hospitals. PONV post-op. Just by cutting out the hospital stay, we save about But all that has changed. Today, we use minimally $5,000. We are in negotiations with insurers about invasive surgery with minimal trauma to the how to cut costs even further by streamlining quadriceps and tendon. Blood loss is minimal payments to the various providers—a step toward because the surgery is so quick; we can complete bundled payments. knees in about 35 minutes, and that will improve. Total I don't want to mislead anyone: There are many hips have undergone a similar evolution. challenges to a program like this. Your surgeon has to Importantly, we no longer use general anesthesia. be efficient. Your anesthesia team must be very Our top-notch anesthesia team uses a low dose skilled with ultrasound-guided nerve blocks and spinal anesthetic for the procedure, a single-shot continuous catheter placement. Your home health sciatic block and a continuous nerve block at the team must have a plan for making sure patients can femoral plexus. Studies show this approach reduces recuperate safely. pain, PONV, respiratory depression, PE and ileus. Still, we believe a revolution is underway. In the U.S., The program has been amazingly successful: we do about a million total knees and hips each year, at a cost of more than $20 billion. Health reform is • All 50 of our patients have gone home after 3 to 4 about improving outcomes and decreasing costs, and hours of recovery, vs. the traditional 2-3 days. that's exactly what our surgical group and ASC are Patients are up and walking in the PACU. They go implementing. This is great for our local community home to a program of aggressive physical therapy, and it will be outstanding for U.S. health care. I don't made possible by their anesthesia. A nurse presee how anyone can argue that point. inspects the home and monitors the patients there for 3 days. There have been no falls. Dr. McClellan is a board-certified orthopedic • Day 1 post-op pain scores are virtually always under surgeon at University Orthopedics Center. 3, and frequently 0; there are very few complaints of Special thanks to David Berkheimer, CRNA, for assistance with this article. The views expressed in this advertorial are those of the author only. Providers and clinicians are obligated to make their own determination of the appropriate medical treatment for each of their patients. Brought to you as an educational service by Circle 135 on the Reader Service Card