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
