3 Trends for Orthopedic Surgery in an ASC

Michael R. Redler, MD, an orthopedic surgeon on staff at the Surgery Center of Fairfield County in Bridgeport, Conn., discusses three trends for orthopedic surgery in an ambulatory surgery center, including specific orthopedic and spine procedures now routinely done in an ASC.

 

1. More minimally invasive cases. Movement of cases into the ASC continues to push forward, now involving more minimally invasive procedures. "Arthroscopic procedures are now often the gold standard for surgery done on most major joints," Dr. Redler says. For example, the five orthopedic surgeons in his practice do all of their rotator cuff repairs arthroscopically. "This allows for improved visualization of the shoulder joint and repairs of even massive rotator cuff tears without the need to cut through muscle and create large incisions," he says. As the instrumentation and skill of orthopedic surgeons has improved with the arthroscopic approach, the need for open procedures has largely fallen by the wayside.

 

2. More use of regional anesthesia blocks. With a higher level of collaboration between ASC anesthesiologists and orthopedic surgeons, more cases can be done under regional anesthesia, eliminating the need for general anesthesia. Axillary blocks can be used for most upper-extremity cases and interscalene blocks and supraclavicular blocks allow for most shoulder surgeries without an absolute need for general anesthesia. "Not only do these patients require less general anesthesia, they are more comfortable in the recovery room, can eat a light meal there and are able to go home sooner with shorter stays in the PACU," he says. "This represents a real cost savings for the ASC."

 

3. Specific procedures now routinely done in the ASC. The following procedures are now routinely done in surgery centers.

 

  • Rotator cuff repairs and shoulder reconstructions. Rotator cuff repairs are now done arthroscopically in the ASC. Shoulder reconstructions for instability can now be accomplished with two or three small arthroscopic portals or puncture wounds, as opposed to a large open incision.

 

  • Cartilage repairs in the smaller joints. Arthroscopy is now performed routinely for smaller joints such as the elbows, wrists and ankles. "We have been able to help pioneer arthroscopic cartilage repairs in the wrist with cases done almost exclusively at Surgery Center of Fairfield County," Dr. Redler says.

  • Scaphoid fractures in the wrist. "Fractures of the scaphoid bone in the wrist are always challenging due to the poor blood supply," Dr. Redler says. In the ASC setting we are able to treat many of these fractures percutaneously under fluoroscopic control with a screw being placed into the bone over a guide wire.  This requires only a single stitch incision.

 

  • Unicompartmental knee replacements. Partial knee replacements are now starting to be done on an outpatient basis. "Smaller incisions and shorter operative time in conjunction with femoral nerve blocks can allow this to be a viable option," Dr. Redler says.

 

  • Spine Surgery. "Spine surgery is the next great horizon for the ASC," Dr. Redler says. Anterior cervical discectomies and fusions (ACDs) and lumbar discectomies are the most common spine cases in surgery centers. Many highly skilled spine surgeons do not require a microscope for these cases, allowing expedited surgery and lower equipment costs. One challenge for spine in the ASC is carving out the reimbursement with insurance carriers. But Dr. Redler predicts success here, given the cost savings and the high quality of care in an ASC.

 

Learn more about Surgery Center of Fairfield County.

 

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