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M A R C H 2 0 1 4 | O U T P AT I E N T S U R G E R Y M A G A Z I N E O N L I N E
highly individualized approach to anesthesia for patients undergoing
total hip replacement. All patients come to our facility for a personal
pre-operative evaluation 7 to 10 days before their procedures for a full
workup. On the day of surgery, our hip patients receive a major con-
duction block as part of our multimodal, non-narcotic anesthesia.
They leave the center with blocks that last up to 24 hours — the
ultrasound guided nerve blocks, strategically placed, let patients go
home pain-free but alert and able to move — and an elastomeric pain
pump that will continuously administer anesthetic through the
femoral catheter for another 48 hours. We prefer ropivacaine because
of its cardiotoxicity profile. Patients also maintain an intravenous line,
so visiting nurses can administer antibiotics or other drugs at the
patient's home, if needed.
Patient selection is really where the success of our same-day pro-
gram stops and starts. We follow strict guidelines when selecting joint
replacement patients. They must be highly motivated, relatively
healthy (1 or 2 comorbidities), ASA 1 or 2, and between the ages of 40
and 65.
When performed in our surgical center, hip replacement costs about
one-fourth of what it would in a hospital: a $15,000 bundled payment at
our ASC, compared to $60,000 at a hospital. As you might expect, insur-
ers have enthusiastically backed our joint replacement program. They
see the great results and the incredible savings. They see us changing
the face of health care. What's not to like? OSM
Dr. McClellan (
cmcclellan@uoc.com
) specializes in total joint replacement.
He is a partner in University Orthopedics Center in Altoona, Pa. Mr.
Berkheimer (
db erk heimer@remca reanesthesia.com
) is president and CEO
of RemCare Anesthesia Solutions in Altoona, Pa.
T O T A L H I P A R T H R O P L A S T Y
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