COVER STORY Conclusion

The state of California has a robust program for performing outpatient total knee arthroplasty (TKA), Gol- logly says. “These procedures are performed safely in an ASC for approximately 50 percent of the cost of the same procedure performed as an inpatient,” he says. “The clini- cal outcomes and patient satisfaction scores are equal to or better than the inpatient environment.” A retrospective review of 100

Patients having surgery in an ASC need to meet specific criteria related to medical co-morbidities, anticipated pain control needs and the extent of planned surgery.”

— Anthony L. Asher, MD, ASCA Board member, Neuroscience Institute at Carolinas HealthCare System and Carolina Neurosurgery and Spine Associates

deliver maximum value, especially, with the higher acuity patients and more complex cases, Jablonski says. “It

is much cheaper to spend two to three nights at an SNF than in a hospital—at least 30 percent cheaper in our market,” she says. “Plus, patients like the security of knowing resources are available to control their pain and that their physical therapy will get started on the right track. Most of our patients want to stay longer because they are being taken care of in a hotel-like environment. Surgeons like it, too, because they can keep tabs on the patients.” If the primary issue preventing

discharge to home is limited to pain control, it would make sense to look

at extended stay, Asher agrees. “Such patients don’t need to be in a hospi- tal, and it would make perfect sense to house them in a CC. Part of the prob- lem, however, is there is presently no good mechanism to reimburse for that service,” he says. “Logically speak- ing, if an extra day in a hospital costs $800 to $900, it surely would make more sense for a patient to stay for half or a full extra day in a modified apartment setting where they would have ready access to an individual with a medical background—an RN or a PA—who’d drop by to check on them. But such an arrangement has to work on both practical and financial levels, in addition to being in the best interest of the patient.”


consecutive patients undergoing total knee replacement at two ASCs in Carlsbad and Monterey, Califor- nia, revealed that the average age of patients was 59.2, there were zero hospital admissions within five days, one ER visit for uncontrolled pain, zero infections and more than 99 per- cent of satisfaction scores, Gollo- gly says. “The conclusion was that patients that score as having minimal or moderate risk using our preopera- tive assessment tool are able to toler- ate outpatient joint replacement sur- gery and leave the center within two hours. Retrospectively, they report high levels of satisfaction, good pain control and minimal risk of readmis- sion or ER visits after the procedure.” Asher’s group has published an

article describing a similar experience in patients undergoing cervical fusion. According to that report, individu- als who received surgery in an ASC achieved equivalent outcomes com- pared to a matched cohort treated in an inpatient environment, with consider- able associated cost savings. “In my experience, it does not mat-

ter which aspect of joint surgery you look at,” Gollogly says. “There have been many peer-reviewed articles writ- ten, if you have a local community that can care for the patients, the surgeries in the outpatient setting will be suc- cessful. That trend is reflected across the country. Patients are going home the same day.”

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