Keys to adding orthopedic procedures to multispecialty ASCs

Multispecialty ambulatory surgery centers are increasingly incorporating orthopedic and spine procedure service lines, which have clear benefits compared to hospital settings for both patients and ASC operators.

During Becker's ASC Review's The Business & Operations of ASCs, in a session sponsored by Mizuho OSI, a manufacturer of orthopedic specialty surgical tables and positioners, two surgeons shared their experiences and discussed the advantages of performing orthopedic and spine procedures at multispecialty ASCs:

  • Carl Wierks, MD, an orthopedic surgeon at West Michigan Orthopaedics
  • Sherwin Hua, MD, PhD, founder of Dimespine Neurosurgery and Spine23 in California

Three key takeaways:

1. The benefits of the direct anterior approach for total hip arthroplasty outweigh those of conventional surgery. Those benefits, which are a product of both human factors and specialized equipment, include:

  • Patient factors: DAA surgery is associated with shorter lengths of stay, smaller incisions, less soft tissue trauma, lower dislocation rate, less pain, more functionality and faster recovery time.
  • Surgeon factors: DAA allows more control over the implant position and easier operative versus non-operative leg-length verification using an alignment rod. "Leg length inequality is the number one reason for a lawsuit after total hip replacement, so we pay really close attention to making sure patients' leg lengths are right," Dr. Wierks said.
  • The Hana® table: Mizuho OSI's orthopedic surgery table, designed to optimize DAA by holding the patient in a proper position, lifting the proximal femur and facilitating leg movement. It has a smaller footprint than other orthopedic tables, thereby taking up minimum storage space, and is perceived as high-end specialized equipment by patients, who sometimes pointedly ask whether they will be operated on it.

2. Keys to a successful orthopedic arthroplasty program at a multispecialty ASC go beyond the center itself. They include aspects that can be promoted from a technological perspective, such as the DAA approach, the Hana table and robotic-assisted surgery, as well as from a relationship perspective, such as patient education, follow-up and a tailored "concierge" experience.

From an economic perspective, ASCs are often associated with less costly procedures for both patients and third-party payers compared to those performed in a hospital setting.

3. To get started with a spine program at an ASC, having a good anesthesia group and investing in a good table are paramount. Because the latter often implies high capital costs that not every ASC may be able to afford, Dr. Hua raised the topic of buying used. He cautioned against purchasing used operating tables online; emphasizing that such equipment often requires having a service contract, which cannot be purchased with unauthorized resold table. Further, installation in a surgical center requires service and support. Dr. Hua then noted, however, that Mizuho OSI's pre-owned, factory-refurbished equipment program can be a solution. "Mizuho OSI has the best of both worlds," he said.


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