Outpatient risk assessment requires an experienced ‘eyeball’ plus predictive tools
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When deciding which patients qualify for outpatient procedures, surgeons should use experienced “eyeballs” with risk stratification assessment tools and neither of these should be used alone, according to an adult reconstruction specialist.
“Because of bundled payments, ASCs and rapid recovery surgeries, we have a number of risk calculators,” Matthew S. Austin, MD, fellowship director and chief of the adult reconstruction division at Rothman Orthopaedic Institute, said in his presentation at the Current Concepts in Joint Replacement Winter Meeting.
Austin cited an old Norman Rockwell painting of a physician examining a patient and determining the best course of action. This use of surgeon discretion is known as the “eyeball,” according to Austin.
General instruments tend to focus on mortality and have poor transferability to an arthroplasty population, Austin said. There are arthroplasty-specific assessment tools like the Outpatient Arthroplasty Risk Assessment Score (OARA), which can give a moderately accurate probability of successful outpatient surgery; however, these tools still struggle to predict complications due to comorbidities, he added.
According to Austin, there are also surgeon and facility factors that can determine the results of an outpatient procedure. Surgeons must be able to get the patient in and out of the operating room quickly and with minimal blood loss. Additionally, the facility must be “a willing and able partner,” and those involved must work as a team, he said.
“In conclusion, you use predictive tools, but you have to use an ‘eyeball.’ We do not have a perfect system yet,” he added.
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Austin MS. Figuring out the right patient: Risk assessment tools vs eyeball. Presented at: Current Concepts in Joint Replacement Winter Meeting; Dec. 8-12, 2020 (virtual meeting).
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