In the years ahead, many industry leaders believe that most outpatient joint replacements will be performed in ASCs.

To improve outcomes, increase efficiencies, and meet patient expectations, surgeons are turning to new surgical technologies that support the value-based needs of the ASC. 

During an OrthAlign-sponsored Becker's ASC Review webinar, three surgeons discussed best practices of successful ASC total joint programs:

  • Michael Ast, MD, orthopedic surgeon and chief medical innovation officer, Hospital for Special Surgery in New York City
  • R. Michael Meneghini, MD, orthopedic surgeon, Indiana University Saxony Hospital in Indianapolis
  • Brodie Wood, MD, orthopedic surgeon, Olympia (Wash.) Orthopedic Associates 

Four learnings: 

1. Multiple factors are driving rapid adoption of outpatient total joint replacements. Before the pandemic, many surgeons invested in surgery centers to control the operating room environment. When COVID-19 emerged, a growing number of elective inpatient procedures moved to the outpatient world. Over time, interest in episode of care cost control has increased and payer demand has grown. In January 2018, CMS removed total knee replacements from the Inpatient Only list and in the last two years, total hips have also come off the list. 

2. Patient selection is critical for successful ASC total joint programs. The ideal candidate is a motivated patient with good home support and minimal to moderate surgical complexity. "Patients need to be in good preoperative physical and mental condition," Dr. Meneghini said. "A lot of our efforts have been on medical risk stratification to make sure we don’t have poorer outcomes." Surgeons have traditionally used American Society of Anesthesiologists scores to medically risk assess patients, but this framework lacks precision. A new system called Outpatient Arthroplasty Risk Assessment is a better alternative. 

3. When it comes to technology, smart instrumentation is a good fit for ASCs. Compared to hospital ORs, ASCs have different patient populations, room sizes, sterilization capacity and cash flow. OrthAlign smart instrumentation works well in the ASC setting. It fits in the sterile field, minimizes trays and sterilization needs, is implant agnostic, has a small footprint and does not have the high upfront and ongoing maintenance costs required by other systems. "Smart instrumentation is accurate and most programs are open platform, so they can be used with any implant. In many ways, it's an optimal technology for getting positive outcomes," Dr. Ast said. “ASC patients are the highest demand and benefit most from advantages of technology.”

4. Computer-assisted surgery tools reduce abnormal implant position, blood loss and revision rates. When surgeons move to the ASC and own the patient experience, they want the position of joint implants to be perfect. "I have a practice where patients expect perfection with their incision and alignment. They want a worry-free recovery," said Dr. Wood. In the ASC, there are many clinical benefits of computer-assisted orthopedic surgery. Notably a marked reduction in abnormal implant position, decrease in blood loss, and lower revision rates in young patients. "We need to offer patients value and excellence and we need tools that offer value and improve the end product. In my practice, OrthAlign has offered that.”

There's little doubt that the shift from the hospital to the ASC will continue. "Our job is to give patients the best outcome we can, and we know that technology improves outcomes," Dr. Ast said. "That's why we should all be thinking about how to adopt new tools in our ambulatory surgery center programs." 

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