The orthopedic field has undergone significant transformations, with surgeons increasingly performing higher acuity cases in an outpatient setting. Albany, Ga.-based Premier Orthopedic Surgery Center surgeons started offering outpatient partial knee replacements in 2011, which helped the ASC prepare for more complex cases, such as total knee replacements. Following success performing knee procedures, Premier had its sights set on total hip arthoplasties with T. Scott McGee, MD, performing the ASC's first THA late last year.
"When I began my residency in 1977, a total hip arthroplasty was a major procedure requiring one to two weeks in the hospital," says Duncan R. Marsh, MD, an orthopedic surgeon who assisted with the center's first THA procedure. "As implants and surgical techniques have improved, the time in the hospital decreased precipitously. As outpatient physical therapy has increased in use and popularity, and pain management techniques have advanced, we have now been able to move THA to the outpatient surgery center."
For THA procedures, Dr. McGee notes the surgery center ensures they have a candidate that meets a certain list of objective physical requirements such as sufficient cardiac health.
"The other part of the equation is more subjective," Dr. McGee notes. "You have to get a feel for a patient that wants to do well while also having family support and a good home environment."
Premier's nursing and surgical tech team plays an integral role preparing patients for surgery and educating them about the entire process so the procedure will reap success.
"We spend a good part of the day with them and their caregiver and go over every aspect from physical therapy to their physician's visit to home care," says Barbara Gosselin, Premier's nurse administrator. "We let them know what they can expect pre-op, post-op and during the procedure. We make sure they are totally comfortable with the whole scenario."
The surgery center implemented certain protocols to prepare candidates for success following a THA. Dr. Marsh said the center's pain management protocol works in tandem with their physical therapy to ensure patients can safely recover at home.
"As we used pain management techniques for other procedures in our ASC, it was a natural step to utilize them in our total hip protocol," Dr. Marsh adds. "It is also necessary to have excellent physical therapists available for rehabilitation."
Premier is working with SwiftPath, which provides computer-based software for communication with patients. SwiftPath has a tracking feature which allows ASC providers to monitor their patients' outcomes and obtain alerts about their recovery process following a procedure. After the surgery center screens patients to make sure they are viable candidates, patients can register for Swiftpath, where they obtain an array of educational tools regarding their procedure and recovery process.
Premier did a great deal of legwork to prepare for the THA procedure, with Jennifer Ban, the center's infection preventionist, noting "we have been working toward this for awhile. We set it all in motion a year ago. It was a natural progression after doing unicompartmental and total knees in the past."
After checking off the first THA procedure, the surgery center is filling its schedule with other possible candidates and continually seeking ways to expand its offerings.
"I would really like Premier to become a joint center," says Ms. Gosselin. "There is not one in this area and it is something we could offer in the future. I would like to be able to furnish whatever is best for the patient."