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I heard there's going to be a shortage of surgeons able to do joint replacements on us older types. What's happening to cause this kind of shift?
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More and more older adults are in need of a total hip revision surgery. Nearly 18 per cent of all total hip replacements done in the United States have to be revised at some point. Current estimates are that in the next 20 years, the need for total hip revisions will increase dramatically.
So how come there's such an increase in the number of revision operations required? And what can be done to prevent this from happening? Studies show that the relative number of revision operations hasn't really increased. It's more the fact that more adults are having their first hip replacement and more of those are being done at a younger age. If patients outlive the life of their implant, then revision surgery is needed. Or if there are complications from the first surgery, a revision replacement might be needed.
As you have heard, there is a shortage of surgeons who perform a primary (first time) hip replacement operation. Joint replacement revision is a subspecialty all of its own. The procedure is difficult and complex.
Surgeons aren't being reimbursed adequately by Medicare. So while the number of older adults needing this operation is on the rise, the number of surgeons available to perform the procedure is on the decline. That presents an interesting dilemma for all concerned.
If revision surgery is going to be a fact in the near future, then what can be done now to head it off at the pass? Some suggest building more high-volume orthopedic specialty hospitals. Studies show that there are fewer complications when a surgeon performs the same operation on a larger number of patients.
Specialty centers of this type would draw more patients and attract more physicians with a subspecialty practice in revision hip replacements. With fewer complications, costs could be contained. Preventing infection, dislocation, or fractures of the bone around the primary implant could go a long way in protecting the implant and reducing the need for revision surgery.
What else can be done about the possible imbalance between supply and demand of specialty surgeons? One natural solution to the problem has already been provided. More non-U.S. trained surgeons are filling surgical positions.
Some suggest putting an end to fee reductions proposed by Medicare. Instead, Medicare reimbursement for primary and revision surgeries must be increased. Otherwise, surgeons will turn to other types of surgeries that pay better just in order to stay in business.
Surgeons have also cited high legal costs of malpractice claims as a deterrent to performing these procedures. Surgeons who perform more than 100 hip and knee replacement operations each year have a much higher risk of being sued for complications such as nerve injury, leg length difference, infection, damage to blood vessels, and implant/joint dislocation. What can be done to reduce complications and the risk of litigation?
Experts suggest developing and using evidence-based guidelines for standard of care, patient safety, reducing complications, and managing patient expectations at the time of the surgery. Added together, these steps represent best-practice procedures for both hospitals and specialty centers. The final result might be total decreased costs as a result of reduced hospital length-of-stay, fewer complications, and fewer revision operations.
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*Disclaimer:*The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic. |
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