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Worth of Every Penny - January 2021 - Outpatient Surgery Magazine

Outpatient Surgery Magazine, providing current information on Surgical Services, Surgical Facility Administration, Outpatient Surgery News and Trends, OR Excellence and more.

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S ame-day shoulder replacements are very much in their infancy, but the migration from inpatient hospitals to ambulatory ORs is moving fast. In fact, the rate at which shoulder replacements are increasing is higher than total knees and hips. This industry-wide relocation will only speed up — CMS is whittling its inpatient-only list and shoulder arthro- plasty is on tap for removal. At Penn Medicine, where I practice, about 300 to 400 total shoulders are performed each year. Many are still done inpatient, but it's only a matter of time before these procedures make the move to outpatient facilities. Focusing on these essential elements of shoulder replacement success will position your facility to capture case volumes that are certain to increase in the coming years. 2 4 • O U T P A T I E N T S U R G E R Y M A G A Z I N E • J A N U A R Y 2 0 2 1 J. Gabriel Horneff III, MD, FAAOS | Philadelphia Are You Ready for the Shoulder Replacement Boom? Outpatient procedures are a growing service line that can be performed safely on select patients. • Pre-op assessments. You need a competent clinical team that confers with surgeons and anesthesia providers to identify appropriate candidates for outpa- tient shoulder replacements. The best candidates for outpatient shoulders have healthy BMIs and no comorbidities such as conges- tive heart failure, COPD, immun- odeficiencies or severe shoulder deformities. I've operated on patients in their teens and some in their nineties, but the majority of patients are arthritis sufferers in their sixties, seventies and eighties. As a new endeavor, you should err on the side of caution until your program is up and run- ning and your team gains experi- ence in performing the proce- dures and managing patient care. • Anesthesia pros. Having a good anesthesia team that is skilled at administering regional blocks and willing to communi- cate with patients about what to expect before and after blocks are placed is paramount. Nerve block recipients will experience numbness in their arm, and per- haps even lack the ability to use their arm for a day or so after their surgery. This could cause undo anxiety if they're not told to expect the lack of sensation in advance, as they'll think it's abnormal and a potentially seri- ous complication. You need an anesthesia group that not only answers calls from concerned patients, but that checks in on the patients proactively after pro- cedures to assess their condition and answer questions they have. • In the OR. Surgical tables GROWTH INDUSTRY Hip and knee replacements still account for the majority of outpatient joint replacements, but total shoulders are increasing at a higher rate. Penn Medicine

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