Surgeon discusses benefits, obstacles of establishing joint replacements at Pennsylvania ASC

Huntingdon Valley (Pa.) Surgery Center performed its first knee joint replacement surgery in December. 

Robert Mannherz, MD, a surgeon who performs the procedure at the center, joined Becker's ASC Review to discuss the obstacles to adding total joints at ASCs in Pennsylvania.

Editor's note: This interview was edited lightly for brevity and clarity. 

Question: What are the benefits to performing total knee joint procedures at an ASC vs. a hospital?

Dr. Robert Mannherz: In our current climate with the COVID-19 situation, being outside of the hospital is a big benefit to the patients. We are essentially COVID-19 free, and we're not dealing with as many patients as a hospital is right now. That's been a big push because we've been working at this for almost a year. Additionally, the overall environment for the patients is more of a low-key place for them to be — most of those patients are done within a 24-hour period and they go home. 

Transitioning to an outpatient environment really isn't that big of a jump from where we might have been five or 10 years ago where patients would stay in a few days. And with healthier patients and with less comorbidities, it's a nice transition for those types of patients.

The other aspect of it is that the overall complication and infection rate is definitely lower in a surgery center because of the type of patients that we treat. I think that tends to create a cleaner environment for the patients. So that's also a plus. Studies definitely show that if you mobilize people quickly, they have less complications. And when you put people into an outpatient environment, you're obligated to do that.

Q: Have there been any obstacles in this process of adding the service line?

RM: The biggest obstacle for us has been working through some of the state regulations. Pennsylvania is probably on the back end of this in terms of approving joint replacements as outpatient compared to some of our surrounding states like New Jersey and Maryland, who have been doing this for a longer period of time. We have to get specific exemptions to be able to do our joint placements in an outpatient environment, and that process was somewhat lengthy to go through. 

I think those things are going to change a little bit as the state accumulates more data to show the fact that ASCs are a safe environment to do these types of procedures. Now that they've been involved in that over the last two or three years, I think the data that they're collecting is showing that this is safe, and so I think they're going to ease up on some of those requirements and hoops that one has to jump through to get to that point.

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