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COVER STORY


TJAs move to ASCs


Total joint procedures in surgery centers tied to top outcomes and cost savings BY SAHELY MUKERJI


T


otal joint replacement proce- dures are rapidly moving into the ASC setting from the hospital set- ting, and physicians expect this trend to continue.


“Based on available data, we feel that there is no statistical difference for readmission, emergency room visits or patient satisfaction in outpatient versus inpatient total joint arthroplasty (TJA),” says Matthew D. Ohl, MD, medical director or Mallard Creek Surgery Center in Charlotte, North Carolina. “In properly selected patients, outcomes of outpatient


TJA are


comparable to inpatient arthroplasty without financially penalizing payers.” According to Ohl, at the American


Academy of Orthopaedic Surgeons 2014 Annual Meeting, David N. Veg- ari, MD, of Main Line Orthopaedics & Sports Medicine in Wynnewood, Pennsylvania, presented a study that


10 ASC FOCUS AUGUST 2015


he and three other physicians con- ducted. “The purpose of the study was to compare readmission rates in patients undergoing outpatient versus inpatient TJA and identify if this vari- able influenced hospital readmissions rates during the 30-day postoperative period,” he says. The study followed 232 patients,


Ohl explains, who underwent an out- patient TJA by one surgeon and 148 patients who underwent inpatient (minimum two-day hospital stay) TJA by another surgeon between September 2010 and May 2011. All patients were matched using the same outpatient criteria. After their surgery, 235 patients (137 outpa- tients and 98 inpatients) completed a telephone survey consisting of 14 questions related to hospital read- missions, unplanned care and patient satisfaction.


“With the numbers available, the study found no statistical differences in readmission rates between inpatient and outpatient TJA,” Ohl says. “Six of 98 (6.1 percent) inpatients were readmitted to the hospital within the first 30 days as compared to 14 of 137 (10 percent) outpatients. When combining emergency room visits with hospital readmissions, 7 percent (seven of 98) of inpatients and 12 percent (17 of 137) of outpatients required unplanned medical care following hospital discharge.” The study also did not find statisti-


cal differences between the two groups when stratified by joint, i.e., hips ver- sus knees, or for readmission during the first four postoperative days. The length of stay had no effect on any patient satisfaction measurements. Thomas D. Wilson, chief executive officer of Monterey Peninsula Surgery Center in Monterey, California, says that at a presentation on TJA at the Orthopedic Academy Meeting held in Las Vegas in April, the consensus


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