Outpatient Surgery Magazine

Orthopedics - Supplement to Outpatient Surgery Magazine - August 2016

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

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1 4 S U P P L E M E N T T O O U T P A 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 6 Dr. O'Grady uses a delta pectoral technique, which is an intramuscular approach that generally limits post-op pain. The procedure involves shaving a few millimeters off the top of the glenoid, a flat oval piece of bone that's part of the shoulder blade. Dr. O'Grady resurfaces the glenoid by reaming it flat and cementing a plastic implant component into the bone. A total shoulder involves replacing both sides of the shoulder joint, while hemiarthroplasty involves addressing either the glenoid or humeral side. "I perform the same procedure in the ASC as I do across the street at the hos- pital," he says. "It's an identical procedure. I tell my Medicare patients that I'm required to hold them hostage overnight because Medicare tells me I have to." The shoulder implant cost is also identical — $7,500 to $8,000. However, the average case payment ensures plenty of margin for the center to profit. "Procedure volume will absolutely increase," says Dr. O'Grady. "Pain and recovery is getting easier for surgeons and patients to manage, primarily because patients are ambulatory immediately after surgery." tion on post-op day 1 when the femoral block wears off. Dr. Hickman also uses a single-shot selective tibial block for posterior anal- gesia in the knee to control pain during the first post-op night. He'll prescribe a 3- to 4-day supply of Robaxin (methocarbamol) to help control mus- cle spasms in the posterior knee. To help manage breakthrough pain, patients are sent home with scheduled gabapentin and NSAIDs while oral opi- oids are used as needed. One of the center's anesthesiologists stays in touch with patients. "If there are any issues, we'll have them back in before the surgeon even knows there's a problem," says Dr. Hickman. Blocks aren't 100% successful, even for the team of anesthesiologists at Andrews ASC, who place close to 3,000 a year. "It's critically important to manage blocks when there's an issue," adds Dr. Hickman. "That's where a lot of providers fall short." — Daniel Cook

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