Babak Baravarian, DPM, is director of University Foot and Ankle Institute and foot and ankle surgeon with Saint John's Health Center in Santa Monica, Calif. Here, he answers questions about foot and ankle surgery and platelet rich plasma injections in the ambulatory surgery center setting. Question: How often does your practice perform procedures in the ASC setting?
Dr. Bob Baravarian: We perform 95 percent of our procedures in an ambulatory surgery center setting. The only procedures we perform in a hospital are major reconstructive surgeries or procedures in patients with restrictive co-morbidities, such as obesity.
Q: What are a few of the most common foot and ankle procedures performed in ASCs?
BB: The most common procedures would be bunion or hammer toe surgery. Ankle ligament and Achilles tendon repair surgeries are also frequently done in the outpatient setting. Achilles tendon repair procedures generally take about 40 minutes and patients are able to go home not long afterwards.
Q: What kind of equipment do foot and ankle surgeons need to perform these cases in an ASC?
BB: Almost every large orthopedic company makes some sort of system that allows surgeons to cut bone and insert pins and screws. We used the Stryker Total Performance System. The goal of a system such as this is to be all-inclusive.
We use the same equipment used in knee arthroscopy, but with a smaller camera. A lot of our equipment has cross over with hand surgery. The knee and hips surgeons will tend to use different equipment. The tools for hand and foot surgery are more delicate.
We use a Mini C-arm, which involves less radiation than its larger counterpart. In addition, a Mini C-arm can be handled by the surgeon without the additional help of a surgical tech.
You, of course, need a supply of screws, plates and anchors. We use two of three vendors and usually have the supplies brought in case by case, so the ASCs do not need to buy in bulk, or we purchase items on consignment.
Q: What are the benefits of bringing these procedures to an ASC?
BB: Performing there procedures in an outpatient setting is beneficial from a time, cost consciousness and patient satisfaction standpoint. The majority of our procedures are done under nerve-block anesthesia. Patients are numb for 24 to 48 hours after the procedure. Patients are able to go home and become comfortable before beginning their postoperative pain control.
As we see continued change in healthcare and greater patient awareness of hospital costs, I think we will see the use of ASCs for ankle, foot and other orthopedic procedures augmented. Physicians are seeing that pain control can be better managed when patients are at home. ASCs have lower infection rates than hospitals and patients want to return home rather than staying in the hospital.
Q: What role do PRP injections play in foot and ankle surgery?
BB: We have done more than 5,000 PRP injections in our practice. These injections mainly play a role in the regeneration of soft tissue. After three to six months, the human body will decrease the inflammatory healing process. In patients with a chronic injury, one of the best options is to increase blood supply to the area. We have had very positive results with PRP injections.
In the ASC setting, we have used PRP injections to augment a lot of our soft tissue procedures, such as ligament repair. We are also using these injections to promote bone healing. In the surgical setting, we have seen the injections lead to quicker recovery times.
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