The Accreditation Association of Ambulatory Health Care Institute for Quality Improvement recently released the data from a survey on performing knee arthroscopy in surgery centers. The survey gathered data from 40 organizations that perform more than 11,000 procedures annually.
"Knee arthroscopy is primarily performed in the ambulatory setting and a proportion of those are done in ASCs," says Naomi Kuznets, PhD, senior director and general manager of the AAAHC Institute. "We are seeing very positive results for knee arthroscopy and it seems to be very effective in the ASC."
She discusses the survey results and what they mean for ASCs today.
1. Appropriate indications. Most organizations reported performing knee arthroscopy for appropriate indications, says Dr. Kuznets. While there are several conditions and combinations of conditions that are indicated for knee arthroscopy, arthritis as a sole indication is not.
"We do see some of the most frequently listed indications for the procedures are the same ones that are listed as an appropriate indication, which is good," she says. "However, there are a few cases where arthritis is the only indication, which is an issue because arthritis alone isn't recognized as an indication for the procedure as such."
2. MRI use. AAAHC is continuing to monitor MRI use prior to knee arthroscopy in an attempt to create an appropriateness indication. The organization is looking at cases where MRIs have been ordered preoperatively and adding the number of MRIs ordered per patient to determine whether multiple MRIs have been ordered per patient, because this would add substantially to the cost per patient.
"For the most part, the number of duplicative preoperative MRIs being ordered is fairly low," says Dr. Kuznets. "However, given the cost of the MRI, even the low number of multiple studies adds up to a lot of money. In our survey, we don't know whether the MRIs are conducted at an in-office imaging center or another location — just that they have been ordered and who has ordered them."
3. Procedure scheduling. Approximately 91 percent of the patients reported scheduling their procedures as soon as they wanted. While an overwhelming number of patients were able to wait less than a month to schedule the arthroscopy, this number has decreased since the last survey in 2000.
"It does seem that it is getting more difficult to schedule a knee arthroscopy," says Dr. Kuznets. "This may be due to several factors, including insurance companies prolonging the process by not pre-approving right away."
4. Pre-procedure time. The median pre-procedure time was 90 minutes, with a range of 60-164 minutes. The organizations with the shortest times attributed their results to preparing the patient prior to the day of surgery and having sufficient staffing.
"With regard to procedure times, we're seeing more preoperative patient education and preparation occur at the organizations before the patient arrives, to reduce the overall procedure time," says Dr. Kuznets.
5. Procedure time. The average procedure time was 7-55 minutes, with a median of 26 minutes. The variation in procedure time can be attributed to several factors, including complication rate. However, Dr. Kuznets says that intra-operative complications are fairly rare when performing knee arthroscopy.
6. Complication prevention. Avoiding infections through appropriate equipment sterilization technique is one way to prevent post-operative complications. There are multiple methods of arthroscope sterilization, which is important for infection control. Ms. Kuznets says 90 percent of the organizations surveyed manually cleaned their scopes prior to sterilization — manual cleaning greatly improves the efficacy of sterilization or high level disinfection processes.
Another focus of complication prevention is avoiding wrong-site surgery. Ms. Kuznets notes that there are three best practices that are recommended to make sure the surgery is on the right site:
• Taking a pause or "time-out" to discuss the procedure preoperatively
• Marking the site with the patient or caregiver present and conscious
• Have the surgeon mark the site instead of a different healthcare professional
7. Discharge time. The median discharge time was 68 minutes, with times ranging from 40-132 minutes. The organizations reporting the shortest times attributed their results to preoperative patient education and short-acting anesthesia combined with local anesthetics.
"We are seeing trends with regard to anesthesia, such as more intra-articular injections to reduce postoperative pain, which seems to be a beneficial trend in terms of patient satisfaction and comfort level after discharge," says Dr. Kuznets.
8. Comfort levels and postoperative mobility. Approximately 99 percent of the patients said they experienced little or no discomfort during the procedure, and 98 percent said they were comfortable post-discharge. "People are reporting being comfortable during and after the procedure and are able to walk within a few days of the procedure," says Dr. Kuznets. "Overall, we continue to see very positive outcomes for knee arthroscopy."
All 100 percent of the patients said they had an adequate understanding of the procedure and received written discharge instructions. When the survey was taken, 97 percent of patients were walking with or without crutches. Around 98 percent of patients said they would recommend the procedure to a friend or relative.
Related Articles on Orthopedics:
Anterior Hip Replacements are the Future: 5 Points From Dr. Edward Petrow
10 Points on Personalized Knee Replacements
Robotics in Orthopedic Surgery: 6 Points on the Present and Future
"Knee arthroscopy is primarily performed in the ambulatory setting and a proportion of those are done in ASCs," says Naomi Kuznets, PhD, senior director and general manager of the AAAHC Institute. "We are seeing very positive results for knee arthroscopy and it seems to be very effective in the ASC."
She discusses the survey results and what they mean for ASCs today.
1. Appropriate indications. Most organizations reported performing knee arthroscopy for appropriate indications, says Dr. Kuznets. While there are several conditions and combinations of conditions that are indicated for knee arthroscopy, arthritis as a sole indication is not.
"We do see some of the most frequently listed indications for the procedures are the same ones that are listed as an appropriate indication, which is good," she says. "However, there are a few cases where arthritis is the only indication, which is an issue because arthritis alone isn't recognized as an indication for the procedure as such."
2. MRI use. AAAHC is continuing to monitor MRI use prior to knee arthroscopy in an attempt to create an appropriateness indication. The organization is looking at cases where MRIs have been ordered preoperatively and adding the number of MRIs ordered per patient to determine whether multiple MRIs have been ordered per patient, because this would add substantially to the cost per patient.
"For the most part, the number of duplicative preoperative MRIs being ordered is fairly low," says Dr. Kuznets. "However, given the cost of the MRI, even the low number of multiple studies adds up to a lot of money. In our survey, we don't know whether the MRIs are conducted at an in-office imaging center or another location — just that they have been ordered and who has ordered them."
3. Procedure scheduling. Approximately 91 percent of the patients reported scheduling their procedures as soon as they wanted. While an overwhelming number of patients were able to wait less than a month to schedule the arthroscopy, this number has decreased since the last survey in 2000.
"It does seem that it is getting more difficult to schedule a knee arthroscopy," says Dr. Kuznets. "This may be due to several factors, including insurance companies prolonging the process by not pre-approving right away."
4. Pre-procedure time. The median pre-procedure time was 90 minutes, with a range of 60-164 minutes. The organizations with the shortest times attributed their results to preparing the patient prior to the day of surgery and having sufficient staffing.
"With regard to procedure times, we're seeing more preoperative patient education and preparation occur at the organizations before the patient arrives, to reduce the overall procedure time," says Dr. Kuznets.
5. Procedure time. The average procedure time was 7-55 minutes, with a median of 26 minutes. The variation in procedure time can be attributed to several factors, including complication rate. However, Dr. Kuznets says that intra-operative complications are fairly rare when performing knee arthroscopy.
6. Complication prevention. Avoiding infections through appropriate equipment sterilization technique is one way to prevent post-operative complications. There are multiple methods of arthroscope sterilization, which is important for infection control. Ms. Kuznets says 90 percent of the organizations surveyed manually cleaned their scopes prior to sterilization — manual cleaning greatly improves the efficacy of sterilization or high level disinfection processes.
Another focus of complication prevention is avoiding wrong-site surgery. Ms. Kuznets notes that there are three best practices that are recommended to make sure the surgery is on the right site:
• Taking a pause or "time-out" to discuss the procedure preoperatively
• Marking the site with the patient or caregiver present and conscious
• Have the surgeon mark the site instead of a different healthcare professional
7. Discharge time. The median discharge time was 68 minutes, with times ranging from 40-132 minutes. The organizations reporting the shortest times attributed their results to preoperative patient education and short-acting anesthesia combined with local anesthetics.
"We are seeing trends with regard to anesthesia, such as more intra-articular injections to reduce postoperative pain, which seems to be a beneficial trend in terms of patient satisfaction and comfort level after discharge," says Dr. Kuznets.
8. Comfort levels and postoperative mobility. Approximately 99 percent of the patients said they experienced little or no discomfort during the procedure, and 98 percent said they were comfortable post-discharge. "People are reporting being comfortable during and after the procedure and are able to walk within a few days of the procedure," says Dr. Kuznets. "Overall, we continue to see very positive outcomes for knee arthroscopy."
All 100 percent of the patients said they had an adequate understanding of the procedure and received written discharge instructions. When the survey was taken, 97 percent of patients were walking with or without crutches. Around 98 percent of patients said they would recommend the procedure to a friend or relative.
Related Articles on Orthopedics:
Anterior Hip Replacements are the Future: 5 Points From Dr. Edward Petrow
10 Points on Personalized Knee Replacements
Robotics in Orthopedic Surgery: 6 Points on the Present and Future