Becker's ASC Review

Executive Briefing: 24 Executive Briefing: DVT Prevention for Orthopedic Surgery Deep vein thrombosis (DVT) occurs in 2 million Americans yearly, hospitalizing up to 600,000 patients. Approximately 40% of DVT sufferers develop pulmonary embolism (PE), causing 300,000 deaths every year in the U.S.—more than breast cancer, AIDs and highway fatalities combined. Compression Solutions provides hospitals and surgical facilities better DVT prevention options to increase patient safety, limit liabil- ity and reduce readmissions. Our continuum of DVT prevention reduces SCD product costs in the facility and provides life-saving DVT prevention to their patients recovering at home when they are at the highest risk. For information on Compression Solutions and our DVT prevention options, call 800-994-0464 or visit www.CompressionSolutions.us . Almost every total joint replacement patient receives intermit- tent compression on their legs at the hospital or surgery center before discharge. The hospital units often have large machines running the compressions, but that isn't the only option. There are small portable compression units on the marketplace now — including systems from Compression Solutions — that allow patients to take the equipment home. "We built a small, portable, easy-to-use unit patients can use in the comfort of their own home and have the same quality of care as the hospital," says Mr. Farrow. The technology also keeps patients compliant. The portable compression system records whether the patient turns it on and how long it's used. The us- age information can be sent back to the company, which pro- vides the information for the patient's physician. "Drugs can't do that," says Mr. Farrow. "Physicians write a pre- scription and hope it gets filled and is used. We have around 90 percent to 92 percent compliance with patients turning on the system." Portable compression technology The portable compression device is placed on the operative extremity, therefore it fulfills the "Stasis of blood" aspect of Vir- chow's Triad by enhancing blood flow. The device also offers an effective alternative to more potent chemical anticoagulants. "There is little risk associated with utilization of pneumatic com- pression devices," says Dr. Lombardi. "They can be applied to the contralateral limb during the surgical procedure and there- fore the DVT prophylaxis is started at the time of surgery." In 2013, AAOS released a statement supporting intermittent compressions. The organization found intermittent compres- sions and 300 mg of aspirin are equal to any anticoagulant on the market. "Our medical colleagues will improve the medical optimization of patients," says Dr. Lombardi. "Therefore, it is my impression that the future of DVT prevention will lean more and more to the use of ambulatory pneumatic compression devices combined with the use of low dose aspirin." Physicians and healthcare providers are under more scrutiny now than ever with transparent quality and pricing metrics. Pro- viders want to make sure their patients feel better as quickly as possible whether they're recovering at home or in a hospital. "We are seeing a big uptick in usage of our product because of the pressures put on physicians to get good outcomes," says Mr. Farrow. "I think it will be a standard because total joints are the highest risk patients. Physicians want to do everything they can to make sure patients achieve a good outcome." Economic benefits The technology is also economically friendly. Most anticoagu- lants for DVT prevention can cost around $500 to $2,100 per prescription from the insurance company, patients or both. But the portable compression system doesn't cost the hospital, ASC or physician; it is typical for companies to bill the patient or in- surance company for the product. "The economic benefit far out-seats what could happen if the patient develops at DVT and the hospital isn't paid for subse- quent treatment," says Mr. Farrow. "A DVT patient could cost the hospital $8,000 to $50,000." The economic benefits fit the technology into bundled pay- ments and the Medicare bundles nicely. When hospitals and ASCs are at-risk for patient outcomes, the intermittent compres- sions can make a huge difference, especially if the technology comes at no-cost to the providers. "We are continuing to see an evolution in the paradigm of how total hip and total knee arthroplasties are being per- formed," says Dr. Lombardi. "Many centers have documented that these procedures can be safely performed in an outpa- tient surgical setting and that patients can be discharged to home the day of surgery. We are witnessing improved pain control which leads to increased ambulatory ability of the pa- tients postoperatively. As more experience is gained in out- patient arthroplasty, more surgeries will be performed in this type of setting." n

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