Friday, March 27, 2015

Opiate use in America: Time to Do Something

Pain is the cognitive, emotional and behavioral response to actual or potential damage to body tissue.
The variation of this response from one person to the other can be night and day.

After an ankle fracture surgery patients in the Netherlands usually take Tylenol while in the Unites States the same category of patient usually takes Percocet, a strong opiate.

80 % of the world's opioids are taken in the U.S..  This high level of use is associated with a high level of abuse and death related to this category of drug.

Part of this difference is mindset:  The Netherlands patient thinks "this is going to hurt" and the U.S. patient thinks "why am I hurting?".

Culture change created this U.S. epidemic.  Together we might affect culture change to solve this social issue.

Friday, March 20, 2015

Ambulatory Surgery Centers May Be Safer Than Hospitals for Surgical Care

A recent article in HealthLeaders Magazine explored the volume, pricing and quality of surgical care delivered in an ASC (ambulatory surgery center). 

The conclusions are that the numbers of ASC's are growing in the U.S. (and this is a good thing).  The good news is that the cost of procedures performed at ASC's are 55% of the  cost of the same service performed at a hospital outpatient department.  Even better, the number of adverse events (complications) are "significantly below the rates reported for inpatient hospital setting".

The explanation, says Michael Cruz, MD, OSF Saint Francis's vice president of quality and safety, is simple. The ambulatory environment "is more expeditious and efficient. Some of our patients are much better served—their patient experience is much improved—than if they were brought to a complicated medical center for a routine procedure. 

At SurgCenter of Greater Phoenix, in Scottsdale, we render same day services for Makoplasty Partial knee resurfacing, Makoplasty Direct Anterior hip replacement, and total knee replacement. Our emphasis is on advancing surgical patient care to the most sophisticated levels found in the U.S..  By offering traditional services using new principles and innovative ideas, our patients experience high quality care,  benefit from going directly home after their procedure and may even save a little money in the process.   

Tuesday, March 10, 2015

Treatment Options for Knee Arthritis

Knee Osteoarthritis Treatment Options – AUC from AAOS A Guide

AUC (appropriate use criteria) are meant to augment—not supersede—clinician expertise and experience or patient preference. The scope of this AUC includes nonpharmacologic and pharmacologic interventions for symptomatic OA of the knee as well as surgical procedures less invasive than total or partial knee replacement.
  • The new appropriate use criteria (AUC) on nonarthroplasty treatment of patients with OA of the knee covers 10 different treatment options and more than 500 patient scenarios.
  • A web-based application ( enables clinicians to submit a patient profile based on specific clinical findings and receive feedback on the appropriateness of various treatment options.
  • Although the AUC addresses the most common clinical scenarios, it does not include all of the possible indications, and is not meant to supersede clinician expertise and experience or patient preference.AUC knee
The full AUC can be found on the website of the American Academy of Orthopedic Surgeons.  Try it yourself.
Open the AUC.  Enter the patient specific information detailing knee pain, knee range of motion, knee stability, knee xray findings, knee aligment (bow legged or knock kneed), meniscal symptoms and patient age.  Enter submit and treatment options categorized as appropriate, may be appropriate and rarely appropriate will be shown.  These options now provide a basis for an intelligent conversation between the patient and the orthopedic surgeon with respect to non surgical and surgical treatment options.

Tuesday, March 3, 2015

ACL Reconstruction with Autograft is the "Best" choice

For primary ACL reconstruction surgery Dr.Tarlow has long favored using an ACL graft from the patient (autograft) due to higher success rates using the patients own tissue with fewer adverse reactions. This post contains a bullet point summary of these facts and a link to a comprehensive review on the topic from the American Academy of Orthopedic Surgery.
  • Patellar Tendon Autograft-
  • often recommended for high-demand athletes and patients whose jobs do not require a significant amount of kneeling.
  • The pitfalls of the patellar tendon autograft are pain behind knee cap, inability to kneel and slightly higher chance of stiff knee.
  • Hamstring Autograft
  • The semitendinosus hamstring tendon combined with gracilis tendon creates a four-strand tendon graft. Hamstring graft proponents claim there are fewer problems compared to the patellar tendon autograft.
  • Less chance for anterior knee pain/kneeling pain, stiffness, smaller incision.
  • Allografts - all tissue types
  • are associated with a risk of infection, including viral transmission (HIV and Hepatitis C), despite careful screening and processing.
  • Recently published literature may point to a higher failure rate (23% to 34.4%) with the use of allografts in young, active patients returning early to high-demand sporting activities. This is compared to autograft failure rates ranging from 5% to 10%. The reason for this higher failure rate is unclear. It could be due to graft material properties (sterilization processes used, graft donor age, storage of the graft). It could possibly be due to an ill-advised earlier return to sport by the athlete because of a faster perceived physiologic recovery, when the graft is not biologically ready to be loaded and stressed during sporting activities. Further research in this area is indicated and is ongoing.

Saturday, February 21, 2015

What Should Knee Replacement Surgery Cost?

Total Knee Replacement is one of the most expensive surgical procedures performed in the United States. Comparing costs for services is confusing to say the least.  Trying to get pricing information using your health insurance is impossible until after the Explanation of Benefits arrives from the insurance carrier.  The best way to compare apples to apples is to compare all-inclusive cash pricing (the price one would pay assuming payment at time of services from the patient to the facility - includes surgeon fee, assistant surgeon fee, anesthesia fee, facility fee and implant cost)
This is also true:  Total Knee Replacement performed in our ambulatory surgery center, SurgCenterGreaterPHX as an outpatient is significantly less expensive than the exact same procedure performed in a Hospital.
Ambulatory Surgical Center: Total Knee Replacement @ SurgCenter GreaterPHX -(implant included)  -- $22,300
Hospital: Total Knee Replacement  @Scottsdale Healthcare Thompson Peak- (implant included) -- $30,700
There are several helpful sites for patients to view
HealthCare Blue Book -- For Scottsdale "total fair price" said to be $22,899. --The United States is known for wide variation in healthcare costs. The average national price for a knee replacement in 2012 was about $20,000 plus the cost of the implant. Implants can cost up to $10,000. - Estimate cash cost to be $35,000 or more for people with insurance but note cash price for uninsured $20,000-$34,000 depending on geographic location. -- The United States has among the highest costs in the world for knee replacement surgery. An American with no health insurance can expect to pay $45,000 – $70,000 at a typical hospital. Those with insurance will, barring a few exceptions, be covered by their provider. However, out-of-pocket expenses can still be costly for those who have health insurance. Patients with medicare are eligible for knee replacement surgery.
Surgery Center of Oklahoma - Price is $19,400 plus the cost of the implant (typically $4,500 - $10,000).