Performing Hand and Upper Extremity Procedures in an ASC Recommendations for optimal outcomes BY JENNIFER PETERSON AND GLENN BUTERBAUGH, MD

Through the years, the sur- gical arena has changed dramatically.

Surgical procedures—particularly hand and upper extremity procedures—that had been performed in hospitals only have now come to call ASCs their home. These procedures have paved the way for more complicated cases to switch venues as well. As surgical care progresses and

evolves, how do we, as health care providers, continue to maximize effi- ciency and still provide the utmost quality of patient care? Are we able to communicate to our patients that their safety comes first? What recommenda- tions can we provide to the leaders of other ASCs to help them perform hand and upper extremity procedures safely in their facilities? At the Western PA Surgery Center

in Wexford, Pennsylvania, a study was conducted and an article was published in The Journal of Bone & Joint Sur- gery on April 20, 2016, on “The Safety of Hand and Upper-Extremity Surgical Procedures at a Freestanding Ambula- tory Surgery Center.” The review con- sisted of 28,737 cases over an 11-year period. Using state-reportable adverse criteria as a guideline, the events were divided into seven categories: ■

infection requiring intravenous antibi- otics or a return to the operating room,

postoperative transfers of patients to an inpatient facility,

■ wrong-site surgical procedure, ■ retention of a foreign object, ■

■ medication error, and ■ bleeding complications.

postoperative symptomatic throm- boembolism,

The results of our analysis revealed

58 reported adverse events that con- tributed to a 0.20 percent overall rate of adverse events. First and foremost, no deaths occurred. Other data analy- sis revealed 14 infections, 18 postop- erative transfers to a hospital, 21 hos- pital admissions after discharge, one medication

error and four postop-

erative hematomas. Additionally, the report showed no instances of retained foreign bodies or wrong-site surgical procedures. The study of 28,737 cases over an 11-year period with an adverse event rate of 0.20 percent shows that hand and upper extremity surgical procedures can be performed safely within the ASC platform. A previous article, “Assessing the

Impact of Antibiotic Prophylaxis in Outpatient Elective Hand Surgery: A Single-Center, Retrospective Review of 8,850 Cases,” published in the Novem- ber 2011 issue of The Journal of Hand Surgery, provides details regarding the use of prophylactic antibiotics and their effectiveness in preventing surgical site infections (SSI). SSIs were reviewed in 8,850 patients over an eight-year time frame. The hypothesis was that preop- erative antibiotics reduce the occur- rence of SSIs. Based on the review of this large group of patients, an infec-


tion rate of 0.35 percent was identified. No benefit was derived from the use of prophylactic antibiotics. The factors that were identified with increased risk of infection were prolonged procedure length, smoking and diabetes. Given the potential complications associated with antibiotic use and the lack of evidence that prophylactic antibiotics prevent surgical site infections, we concluded that antibiotics should not be routinely administered to patients that undergo clean elective hand surgery.

Suggested Effective Strategies While businesses in corporate Amer- ica thrive on their productivity, they also keep the reasons for their success close. In the health care community, however, it is important to compare findings, analyze benchmark compar- isons and compose reviews compara- ble to our published studies referenced above in The Journal of Bone & Joint Surgery and The Journal of Hand Sur- gery. Health care is a data-driven soci- ety. Data collected, whether qualitative or quantitative, fuels change, ensures the integrity of the inquiry and has the ability to keep us in tune with what is the most optimal outcome for our patients’ surgical safety and success. The first recommendation for ensur- ing that hand and upper extremity pro- cedures can be performed safely in an ASC is “collect data.” Then, raise the bar and continue submitting quality reports and benchmarking data. Gather information to grow your organization’s collection of resources. Publish the data in

peer-reviewed journals; Medicare and insurance companies gather their information from these sources. Data collection and studies also can

raise awareness of disparities within an ASC. These disparities can increase the

The advice and opinions expressed in this column are those of the authors and do not represent official Ambulatory Surgery Center Association policy or opinion.

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