Nicholas Grosso, MD, is the president at The Centers for Advanced Orthopaedics in Columbia, Md. Here, Dr. Grosso discusses current trends in outpatient orthopedics and how the industry and patients could benefit from allowing longer stays at ASCs.
Note: Responses have been edited for style and clarity.
Question: How could increasing the maximum stay time at ASCs from 24 to 48 hours benefit a center?
Dr. Nicholas Grosso: Extending the maximum stay time at ASCs to 48 hours would make outpatient surgery a safer option for a wider variety of patients, like those who may be at-risk for surgical complications, allowing more patients to undergo surgery in this setting. ASCs are primarily used for routine hand, elbow and shoulder surgeries, as well as foot and ankle and knee procedures. The extended stay would most impact hip, knee and shoulder replacements and spine surgeries. Most patients having these surgeries do not need the full 24-hour window, as new techniques to control pain like multimodal pain management and catheters allow patients to be released more quickly. However, allowing a 48-hour stay would give at-risk patients the opportunity to realize the benefits of outpatient surgery, too.
Q: What trends are you seeing right now in outpatient orthopedics?
NG: In recent years, we have started to see a wider variety of the types of surgeries being performed in the outpatient setting. In addition to total joint surgeries like hip, knee and shoulder replacements, anterior cruciate ligament reconstruction and rotator cuff repairs are now routinely done in the outpatient setting without any increased risk for the patient. In fact, I’ve noticed private practice physicians are moving as many surgeries as they can into outpatient centers, where patients see significant cost savings with positive surgical outcomes.
Q: How do you hope the ASC industry will change in the coming years?
NG: I hope that all states will embrace ASCs through recognizing that surgeries done in this setting are not only more cost-effective, but also lead to high-quality outcomes and increased patient satisfaction. Some states have done a better job than others at introducing legislation that will increase patient access to outpatient surgery. I practice in Maryland, where we were recently granted the ability to utilize two operating rooms at once in an ASC. With two rooms, we can take on more cases that are appropriate for outpatient surgery, offering even more patients the cost savings associated with outpatient care. I anticipate that we’ll see more changes like this one in the next few years.
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