Is the in-office surgery setting safer than in-hospital surgery in COVID-19 pandemic?
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Shift in appropriate site of service
COVID-19 has had huge ramifications for our society and our profession in general. However, one silver lining we are experiencing is a monumental shift in the appropriate site of service for orthopedic procedures.
Whether it is total joints or arthroscopy, the trends of shifting these procedures safely to a lower acuity, less costly site of service have seemingly increased in our area.
As an arthroscopist, the advent of needle arthroscopy has shifted dramatically my approach and site of service in both the diagnosis and treatment of many common conditions. From a diagnostic perspective, I have had more patients requesting an in-office diagnostic arthroscopy in comparison to going to yet another facility, sometimes one in the hospital setting, and obtaining an MRI. From a treatment standpoint, I am still performing arthroscopic treatments in the ASC in either an OR or procedure room, but one distinct change that we see in our patients is anesthetic choice. For example, more patients during this pandemic are choosing to undergo knee arthroscopies with just local anesthetic and, within my practice, there is a dramatic shift to focusing on a “safer” venue for the surgery to be performed. Many of my patients are adamant about avoiding the hospital for any reason, and I believe this pandemic has significantly accelerated the transformative site of service shift as consumers’ perception of safety, and now comfort, appears to be evolving more rapidly toward the outpatient setting.
Matthew Daggett, DO, MBA, is an orthopedic surgeon at Sano Orthopedics in Kansas City, Missouri.
Disclosure: Daggett reports he is a consultant for Arthrex.
Increase in in-office procedures
COVID-19 has changed health care in many ways since we here in New York first experienced its destructive power in the spring. Elective surgeries were canceled in March and health care workers manned the ramparts to do what they could to stem the tide of this dreadful disease. Because of the enormous efforts made by the people of New York City and its health care workers, the worst of the pandemic was over in June and we opened our elective surgery units once again.
Patients considering scheduling orthopedic procedures should be assured that hospitals, like NYU Langone Health, are taking all the necessary measures to keep them safe and if an orthopedic procedure is indicated, now is a good time to do it.
Despite the number of elective surgery cases declining over the early course of the pandemic, there was a corresponding increase in “in-office” procedures in certain divisions. For example, in NYU Langone Health’s foot and ankle division, the number of needle arthroscopic surgeries increased dramatically throughout this time. In a similar fashion, orthobiologic injections increased. Because of advances in technology, such as needle arthroscopy, which allows the clinician to look into the joints of the ankle or foot and perform a procedure while the patient is under a local anesthetic, we are able to provide alternatives for worried patients who are looking for solutions to their pain and discomfort and perform in-office procedures after which patients are able to walk out immediately. The use of needle arthroscopy and biologics is a trend I anticipate will experience increased utilization even after the COVID-19 pandemic is over.
John G. Kennedy, MD, is a professor of orthopedic surgery and chief of the division of foot and ankle surgery at NYU Langone Health in New York.
Disclosure: Kennedy reports he is a consultant for Arthrex and Isto Biologics.