Orthopedics
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Home in a day: Advances in joint replacement surgery
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Hip and knee replacements have grown to become one of the most popular and successful elective operations ever performed. According to the Centers for Disease Control and Prevention, there were 1.1 million total joint replacements performed in the U.S. in 2012. Estimates show that by the year 2030, there’ll be 572,000 hip replacements and 3.48 million knee replacements performed annually in the U.S.
Given the high demand, hospitals are studying ways to best provide this care to patients. This is especially true at Anne Arundel Medical Center.
When I started doing joint replacement surgeries 13 years ago, the average length of stay for a patient who had hip or knee replacement was three nights. This is changing. Patients are going home sooner.
For instance, four years ago at AAMC, only 10 percent of patients who had hip and knee replacement surgery went home on the first postoperative day. This year in July, we saw 80 percent of patients who had a hip replacement, and 60 percent of patients who had a knee replacement, go home in one day. This includes a growing number of patients going home the same day of their procedure.
How is it possible to be discharged the next day, or even on the same day, after this type of procedure? The answer lies in a team approach always focused on the patient. There are a growing number of programs focused on helping speed up postoperative recovery, supporting early discharge and decreasing postoperative complications after joint replacement surgery. Locally, there is the Enhanced Recovery after Surgery (ERAS) program at AAMC.
Early on, we were concerned that with a shorter length of stay patients may need to come back to the hospital with medical or surgical issues, but this was not the case. Our data shows that earlier discharge does not increase re-admissions. With high-quality hip and knee replacement surgery, patients have a safe recovery — even when they go home on the day of surgery.
Advancing outcomes in joint replacement surgery
Hospitals and surgeons continue to engage in work to further improve joint replacement care. Here in Annapolis, the joint replacement team at AAMC is developing clinical programs to increase the number of patients who leave the hospital earlier and get on the road to recovery faster.
And by using predictive models, we’re able to better understand and choose patients who are good candidates for going home on the day of surgery.
Postoperatively, we’re working closely with physical therapists to develop protocols to use after surgery to accurately show when a patient is safely ready to go home.
Our efforts are focused on early recovery, to get you back to your own home and normal life sooner without hip or knee pain.
Author
James MacDonald, MD, is a joint surgeon at the Center for Joint Replacement at AAMC. To see the latest outcomes report from AAMC’s Center for Joint Replacement, visit askAAMC.org/JointOutcomes. To reach his practice for an appointment, call 410-268-8862.
News & Press Releases
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Surgeon’s new book is complete how-to guide for bringing safe, affordable surgical care to developing countries
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In 2015, the World Health Organization (WHO) passed a resolution calling attention to improving universal access to safe and affordable surgical care. Why? Of the world’s seven billion people, five billion lack access to the most basic surgery.
Otherwise simple conditions, like a bone fracture or dislocation, a hernia, cataract, or obstructed labor, often turn life threatening for people living in many of the world’s developing nations.
“In the developing world, surgery has been viewed for a long time as a luxury for the rich,” says Adrian Park, MD, chair of the Department of Surgery at Anne Arundel Medical Center (AAMC).
But now, he says, the need for better surgical care is too great to ignore.
“Data shows the burden of illness for surgically correctable conditions in the developing world eclipses that of malaria, HIV, AIDS, or tuberculosis,” says Park. “It is so significant that this can no longer be viewed as a luxury for the wealthy, this has to be viewed as a human right to have access to safe surgical care.”
One part of the solution: equipping surgeons with skills to manage the challenges of surgical care in low- or limited-resource settings. In his new book, “Global Surgery: The Essentials,” Park provides an unprecedented resource for surgeons who have a desire to become involved.
Coedited by University of Utah’s Raymond Price and published this year by Springer International, the book provides a ready guide for surgeons to manage clinical scenarios beyond the scope of their training or current practice. It also provides an in-depth look at unmet needs, and epidemiological, socioeconomic and political factors that frame global surgery.
Park says his desire for readers is to become a part of efforts with lasting impact. “I want readers to think beyond just being a ‘drop in the ocean,’ but look to deliver sustainable change in providing access to safe surgical care in lower resource and remote settings.”
He adds that sustainable change will also come from training those in low-resource settings to become surgeons — work he is actively engaged in. But that, he says, will take time.
Park sees the heightened awareness and increased efforts around global surgery as promising. He is a part of work to facilitate the WHO resolution for access to safe, affordable surgical care for 80 percent of the world’s population by 2030.
Park is a member of the American Surgical Association and fellow of the Royal College of Physicians and Surgeons of Canada, American College of Surgeons, and the College of Surgeons of East, Central and Southern Africa.
He is author of more than 200 scientific articles and book chapters, and is internationally known as a leading authority in minimally invasive surgery. Park is also co-editor and chief of Surgical Innovation, a peer-reviewed bimonthly journal.
Global Surgery is available for purchase on the website of Springer International Publishing and on Amazon.com.
Cancer Care, Men's Health, Women's Health, Pediatrics
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AAMC partners with area pediatric practices to educate on HPV vaccine
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The Geaton and JoAnn DeCesaris Cancer Institute at Anne Arundel Medical Center is partnering with two leading area pediatric practices to help raise awareness, and educate parents and health care providers about the importance of the HPV vaccine as a form of cancer prevention.
About nine in 10 people will be exposed to HPV, or human papillomavirus, in their lifetime. According to the Centers for Disease Control and Prevention (CDC), nearly all cases of cervical cancer can be linked to HPV. Experts say HPV also causes between 50 to 60 percent of cancers, including cervical cancer, vaginal and vulvar cancers, anal cancer, throat cancer and penile cancer.
“Despite the potential to drastically reduce the number of HPV-related cancers and other diseases, the HPV vaccine has not gained widespread use,” said Luqman Dad, MD, radiation oncologist at AAMC and chair of the medical center’s HPV vaccine taskforce. “We want to see that change because when HPV infections persist, people are at risk for cancer. Raising awareness about the safety and effectiveness of the HPV vaccine is important to us as health care providers. We want parents to know that the HPV vaccine is cancer prevention, and vaccine benefits far outweigh the risks.”
“We are excited to join this group of experts to highlight the importance of HPV immunization for children in our community,” said Charles L. Parmele, MD, chief medical officer of Annapolis Pediatrics. “We understand there are many misconceptions about the safety and effectiveness of this vaccine. As pediatricians, this is a great opportunity for us to provide accurate information so parents can make the best decisions on behalf of their children today to reduce their risk of cancer in the future.”
The CDC and Food and Drug Administration (FDA) have studied the vaccine carefully and determined it is safe. The HPV vaccine has many of the same, mild side effects as other vaccines. The most common side effects reported after vaccination are minor and include pain, redness or swelling in the arm where the patient received the shot; fever; headache or feeling tired; and nausea.
“HPV vaccination is an integral part of preventing cancers in young women and men. It is important for families and primary care providers to have an early, open dialogue about the benefits of the HPV vaccine,” said Robert G. Graw, Jr., MD, chief executive officer and founder of the Pediatric Group and a pediatric oncologist at AAMC.
Doctors recommend that children get the vaccine before they become sexually active, which is when it is most effective.
Boys and girls who are 11 or 12 years old should get two shots of HPV vaccine six to twelve months apart. Children who receive their two shots less than five months apart will require a third dose of HPV vaccine. If your child is older than 14 years, three shots will need to be given over 6 months. Visit askAAMC.org/HPVvaccine for more information.
Cancer Care, Men's Health, Women's Health, Pediatrics
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The HPV vaccine: A vaccine that prevents cancer
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Immunizations to control serious vaccine-preventable diseases are considered one of the greatest public health accomplishments of the 20th century. Research continues to make progress in unlocking the potential of vaccines in preventing and eliminating diseases, including cancer.
The most recent FDA-approved cancer control vaccine is the human papilloma virus (HPV) vaccine, designed to prevent infection from HPV and ultimately prevent cancers associated with the infection. Immunization against HPV could prevent 40,000 cases of HPV-associated cancers every year in the U.S.
HPV is a common virus that can be transmitted skin-to-skin between individuals and infects most men and women at some point in their life. The immune system is effective in clearing the body of HPV infection but in some cases the infection remains, which can lead to the development of illnesses. These illnesses include genital warts, pre-cancerous cervical changes (dysplasia) or cancers of the cervix, penis, anus, rectum, and oropharynx (throat, tonsils).
HPV causes virtually all cases of cervical cancer and is responsible for more cancers than any other group of viruses. HPV is a sexually transmitted infection common among adolescents and young adults. Most HPV infections have no symptoms.
The reason the vaccine is recommended before adolescents become sexually active is because it is much more effective at a younger age and can ensure protection before likely exposure to these viruses. Vaccines mobilize the body’s natural defenses to fight infections and the HPV vaccine works best if given before there is any chance of exposure, when there is still time to build up immunity. The prevention of infection is ideal for the prevention of diseases, including cancer.
In 2006, the HPV vaccine became available to females, ages 9 to 26, and later, in 2010, the vaccine was also recommended for males of the same age group. According to the Centers for Disease Control, the HPV vaccine is routinely recommended for boys and girls at ages 11 to 12, but can be given as early as age nine. Health experts recommend a two-dose schedule for kids starting the vaccine at ages 9 through 14, and a three-dose schedule for those who start the series at ages 15 through 26. Under the three-dose schedule, the second dose of the HPV vaccine should be given 1-2 months after the first dose, and the third dose should be given six months after the first dose.
Studies show the HPV vaccine is fully effective for at least ten years. And research has shown the vaccine is safe with very few side effects. Individuals with a severe allergy to yeast or latex should not receive the vaccine. Talk to your child’s pediatrician for specific recommendations.
Despite the potential of the HPV vaccine to drastically reduce the number of HPV-related cancers and other diseases, the vaccines have not gained widespread use. After more than a decade of encouraging news about the effectiveness and safety of the vaccine, completion rates for the HPV vaccine series continues to hover around 48 percent in Maryland for adolescent girls and boys.
The more adolescents and young adults who complete HPV vaccination, the more beneficial the protection will be for the entire population. Perhaps the greatest accomplishment of the 21st century will be to dramatically reduce the number of HPV-related cancers.
You can find more information about HPV immunization at askAAMC.org/HPVvaccine.
Author
By Joanne Ebner, RN, BSN, OCN, C-TTS, a cancer prevention program supervisor at Anne Arundel Medical Center.
News & Press Releases
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AAMC Chief Nursing Officer Honored by American Association of Critical Care Nurses
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Anne Arundel Medical Center (AAMC) Chief Nursing Officer Barbara Jacobs recently received national recognition for reaching a significant milestone in the nursing profession. Jacobs is one of 521 critical care registered nurses (CCRN) being honored this year by the Certification Organization for the American Association of Critical Care Nurses (AACN).
CCRN certification is one of the most advanced professional credentials that can be achieved by a nurse in the field of acute and critical care. As a result, the CCRN credential is highly regarded as recognition of advanced knowledge and clinical expertise in the care of acutely and critically ill patients and their families.
In a letter of recognition, AACN CEO Dana Woods said, “Achieving and maintaining the CCRN credential over time decades takes passion, perseverance and advanced clinical knowledge, and demonstrates a lifelong commitment to patients, families, colleagues and employers.”
Jacobs joined AAMC as chief nursing officer in 2015. Prior to AAMC, she served as chief nurse officer for John Hopkins Suburban Hospital.
As chief nursing officer for AAMC, Jacobs works with nursing staff and nurse leaders, physician and multidisciplinary team members, auxilians, and patient and family advisors to continue building on important nursing initiatives, patient satisfaction and wellbeing. She also leads the refinement and implementation of the nursing strategic plan.
Jacobs received a bachelor of science in nursing from the University of Rochester and a master of science in nursing and management from George Washington University.
