Hand and Upper Limb Orthopedic Surgeon Dr. Alejandro Badia Notes The Benefits of Outpatient Joint Surgery are Self Evident, but says COVID-19 Increased Patient Awareness

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Dr. Badia Offers Patient Tips on the Benefits of Outpatient Joint Surgery

Dr. Alejandro Badia

Outpatient surgery with same-day discharge offers a much safer, more efficient and far less costly option for those struggling with the pain of diseased joints.

March 2021 - More and more joint replacement surgeries are being performed in the outpatient setting – and “we can thank a virus for part of that trend,” according to orthopedic surgeon Alejandro Badia MD, who notes the move from inpatient to ambulatory surgery is proving “a major plus” for patients in terms of recovery time, outcomes, and reduced cost.

“Just as the COVID-19 pandemic is transforming the workplace, education, and the arts and proving that use of technologies like Zoom can be effective, so it is changing – for the better – the way we deliver health care,” says Dr. Badia, a Miami-based specialist in treating musculoskeletal disorders of the upper limbs. He is founder and medical director of the Badia Hand to Shoulder Center and OrthoNOW®.

“For good reason, people have been avoiding emergency rooms and hospital stays because of fears of developing hospital-acquired nosocomial infections like antibiotic-resistant MRSA or being in close contact with COVID-infected patients,” he says. “Outpatient surgery with same-day discharge offers a much safer, more efficient and far less costly option for those struggling with the pain of diseased joints. In fact, patients able to take advantage of outpatient joint surgery recover more quickly at home, require less reliance on analgesic medications to relieve pain, and experience fewer, if any, postsurgical complications, such as infection and blood clots.”

Research backs him up.
In a study published in a 2018 issue of the Journal of American Academy of Orthopaedic Surgeons, authors write that “shoulder arthroplasty (joint replacement) can be performed safely and predictably” in an outpatient setting “in [carefully] selected patients.” They also refer to findings from the National Surgical Quality Improvement Program, showing that total shoulder joint replacement performed as outpatient surgery resulted in a 30-day adverse event rate of only 2.3 percent compared to 7.9 percent for the same procedure done in the hospital. The 30-day readmission rate following outpatient shoulder arthroplasty was 40 percent below that for the same inpatient operation.

As early as 2014, researchers reviewed nearly 30,000 outpatient surgeries involving the hand and other upper limbs and determined that the overall patient complication rate was less than a quarter of a percentage point, Dr. Badia says.

Another study, this one in the April 2018 journal Arthroplasty Today, reports “increasing interest in outpatient total joint arthroplasty” due to “perceived advantages for the patient, potential cost reduction and general benefits to the health care system.” Other research finds patients recover more quickly at home than in the hospital. And an article in the December 2020 Journal of Shoulder and Elbow Surgery (JSES) states that “early discharge [is] a target of cost-control efforts given the growing demand for joint replacement surgery.”

“In some instances, cost savings for patients undergoing outpatient joint surgery can be as great as 40 percent or more,” says Dr. Badia. He refers to an analysis of costs for total shoulder arthroplasties performed between 2010 and 2015. Inpatient hospital procedures averaged more than $76,000, while the same surgeries performed on an outpatient basis cost less than $23,000, according to the review, which appeared in a 2019 issue of JSES.

Dr. Badia credits improvements in minimally invasive surgical techniques and continuing enhancements of high-tech tools, including robotic instruments, augmented reality, and 3-D printed implants, for facilitating surgeons’ ability to perform more complex joint operations effectively outside expensive hospital operating rooms. As an example of a recent orthopedic advancement, Dr. Badia cites the FDA’s approval in 2020 of a joint replacement device for patients with wrists that are severely affected by osteoarthritis. “The device is computer-designed to mimic the actual motion of the human wrist,” he says.

Well known for his application of innovative business principles and technology to enhance health care delivery, Dr. Badia authored a book, Healthcare from the Trenches, in 2020. In it, he details barriers that have led to “skyrocketing health costs, lack of patient access, and inefficient delivery of care.”

“We have the capability to create a health system that can deliver higher quality, less costly care for the ultimate benefit of our patients. What is needed now is a paradigm shift in thinking and attitude by both the public and third-party payers,” Dr. Badia says. “Indeed, health care can be effectively – and safely -- delivered outside the hospital.”

Although not every patient in need of joint replacement is an outpatient candidate, Dr. Badia offers these tips for those considering ambulatory surgery as a possible option:

  • Select an orthopedic surgeon with extensive clinical experience – and a high rate of success – in performing outpatient joint procedures.
  • Participate in a pre-surgical patient education program about the planned surgery.
  • Manage expectations and maintain a positive attitude.
  • Be prepared to get home as quickly as possible and begin the recovery process.
  • Commit to closely following your physician’s post-surgical instructions.
  • Make sure you have strong social support, namely, family members – or friends -- on whom you can rely during rehabilitation.

“And know that it has taken a pandemic to make all of us more health conscious, more respectful of the safety and health of others in our community, and more motivated to move our heath care system in the right direction,” Dr. Badia says.

Bio: Alejandro Badia, MD, FACS, is an internationally renowned hand and upper-limb surgeon and founder of Badia Hand to Shoulder Center and OrthoNOW®, a network of walk-in orthopedic centers. Dr. Badia is the author of Healthcare from the Trenches. http://www.drbadia.com http://www.orthonowcare.com

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