The game-changing joint replacement procedures developed by the Bucks County orthopedic surgeon and his team are turning heads, and saving time and money for his patients while improving their quality of life.
Forgive Dr. Thomas Vikoren if he always seems to be in a hurry. It’s his nature. One thing though, the good doctor is in a hurry for good of his patients.
He knows the simpler and faster his knee and hip replacements are completed, the better the results will be for the men and women he is caring for.
Three years ago, while practicing out of the Bucks County Orthopedic Specialists offices in Doylestown, PA, Dr. Vikoren was working his “Dash” program that was getting patients their knee and hip replacements done with hospital stays of just 24-36 hours with little or no opioids being used in the procedure.
Today, out of his new facility, Bucks County Surgical Suites in Warrington, PA, Dr. Vikoren and his team have not only gotten the procedure down to less than a day, with even less need for traditional, addictive pain medicine, they have eliminated the hospital stay altogether.
It took over a year and a half simulating the same-day procedure in a hospital before the State of Pennsylvania Board of Health would grant them the license to operate what Dr. Vikoren calls a “free-standing, same-day surgery center.”
HOW THE GOAL OF SAME-DAY REPLACEMENT SURGERY UNFOLDED
In a recent interview with Footballstories, Dr. Vikoren talked about his journey to realize his goal of opening Bucks County Surgical Suites as a full time facility to perform hip and knee replacements.
“We had to really start from scratch you might say, with the state,” Dr. Vikoren said at his new Warrington digs. “Opening up a whole new category. Showing them that we were able to do go-home-the-same-day replacement surgeries, (at first) in a hospital setting for a year and a half. We did, and had no complications with that method of doing a procedure.”
Dr. Vikoren, his associates and staff had to simulate the same-day procedure at a traditional hospital for a specific amount of time before the Board of Health would allow him to open his same-day facility.
“Meaning they wanted to see the results of every surgery we did,” Dr. Vikoren said.
Dr. Vikoren said the patients involved in the simulation were all fine with it, but never had their actual names shown to the board, “just their initials.” He said his staff only turned over the results.
“Every patient we treated over about a year-and-a-half time, we submitted results of those patients’ success,” he said. “The same-day surgery was done in a hospital setting. The state reviewed all that and said ‘It looks like you’re ready for us to come out and see if you can do it in a free-standing setting.’
Dr. Vikoren said there were places that have asked the state to do the go-home-the-same-day replacement surgery and a free-standing or Ambulatory Surgery Center (AFC) setting. But those other centers were told by the state they were not ready yet.
Dr. Vikoren said he was determined not to get turned down: “When they (the state) looked at our results from doing these same-day surgeries in the hospital settings they said ‘this is looking great.’”
Dr. Vikoren said he amassed about 700 pages of protocol of every possibility that could happen. He said he and his staff were ready for any challenges the Board of Health or just life would present his new and advanced way of performing replacement surgery.
“What if they can’t go home?” Dr. Vikoren said when asked for examples of challenges that might come up. “What if they get to their house and they need help? Things like that.”
Dr. Vikoren talked about the multiple stages this process was done in. He said first, it was the hospital for the simulations, then at their new facility on a trial basis, then the approval.
Dr. Vikoren said he believes there are only three facilities doing same-day, free-standing Ambulatory Surgery Centers in the state of Pennsylvania that have been granted the right to open to the pubic. His facility is one of them.
Said Dr. Vikoren ”By virtue of our quality, to the go-home, same-day replacement surgery procedures. We made extensive protocols culminating in the coming-out and observing these go-home-same-day surgeries here (at their new facility) for both hip and knee replacements and granting us the right to do about a dozen patients, then submitting the results from those patients and seeing how they did…they all did great. Then we ultimately got the green light.”
HOW DOES SAME-DAY SURGERY HELP THE PATIENT AND MEDICAL SYSTEM?
Dr. Vikoren offered reasons why his same-day replacement surgery is more beneficial for those who qualify; meaning they are just getting a knee or hip replacement with no situations with existing problems, like infection issues.
“Why would someone want to do it this way as opposed to the hospital way?” Dr. Vikoren said. “There are a number of different reasons why this could be beneficial.”
His list:
* The patient experience standpoint. It’s excellent. People’s family are right here. They know their dad or husband is having surgery 50 feet away. If they have a question, they can just walk up to the desk. It’s not the enormous hospital institution…parking in a parking garage…all that…you are parked right next to the building.
* We only do clean surgery here. We don’t do any infection surgery. Infection in a replacement is a bad situation. You can’t just give medication. You have to go in and clean it out, sometimes more than once. Sometimes you have to change out the parts. That’s one of the biggest factors.
* More simplification to the process. That adds safety to the patient. In a hospital setting there are a lot of moving parts. Instruments are being sent down to be processed for other surgeries. Patients are coming and going, there are emergency cases. The anesthesiologist who is doing the anesthesiology for the surgery; their attention could never be drawn away because there’s nowhere for them to be drawn away to. There is no baby to deliver, there is no emergency in the intensive care unit. The attention is solely on our patient. That’s all we have here.
* From the perspective of the patient and the perspective of the insurance company and society in general, this is way less costly to have the exact same surgery here than it is to have it in a hospital setting.
Dr. Vikoren says his facility is like a “One-trick pony.”
“We can be very focused and much more efficient at what we need to do,” Dr. Vikoren said.
Dr. Vikoren was asked if he believes his facility helps the hospitals as well, since there are less patients who could be tying up equipment and/or space from patients who are in a more time-sensitive situation. “Absolutely.”
DOCTOR VIKOREN'S EDUCATIONAL BACKGROUND
Dr. Thomas Vikoren is certified by the American Board of Orthopedic Surgery and specializes in hip and knee replacements with rapid recovery protocols. He is a member of the American Association of Hip and Knee Surgeons.
Dr. Vikoren graduated cum laude from Dartmouth College where he completed his undergraduate studies. While at medical school at the University of Pittsburgh, he was inducted into the Alpha Omega Alpha Honor Society and received the University of Pittsburgh Medical School Alumni Association Research Scholarship upon graduation in 2012.
Dr. Vikoren completed his internship in 2002 and residency in 2007 at Duke University Medical Center and acted as the Chief Resident from 2006 to 2007. He finished his fellowship in Adult Joint Reconstruction at Harvard Medical School/Massachusetts General Hospital in 2008.
THE IMPORTANCE OF BEING CREDENTIALED BY THE STATE Dr. Vikoren said since this is so new, it was important that the public know the Board of Health was monitoring every step he and his team took. People are and should be skeptical. Patients in the past, getting replacement surgery would have had them in the hospital for a week or two, are now in and out in less than a day. That is remarkable. And that is why Dr. Vikoren wanted the scrutiny and authorization from a trusted source.
“It’s important to know how we’re credentialed,” Dr. Vikoren said. “We’re credentialed as a free-standing surgery center by the State of Pennsylvania Board of Health.”
The doctor continued“The reason that’s special is that when Pennsylvania made the laws governing surgery centers back in the 1980s, they never even dreamed that hip replacement surgeries could be part of the surgery center.“
He said orthopedics were not on lawmakers radar when the medial requirements were being formed and put into place three decades ago.
Said Dr. Vikoren: “The laws that stated the kind of surgeries that would be appropriate for a surgery center never even talked about replacements.”
Dr. Vikoren said it never occurred to these regulatory offices to consider hip and knee replacements in their evaluations because patents normally took up to two weeks to complete when these procedures were done in the 80’s.
“It was impossible,” Dr. Vikoren said. “As things have moved forward like this 'Dash' program from a few years ago, around the country, the recognition that this is a beneficial thing for patients has grown. And what has happened is that people, like the state board of health, have realized that there are advantages to patients to doing it this way.”
He continued: “This is an extension of the ‘Dash’ program,” Dr. Vikoren said. “but taken to the next level.”
The doctor said his new program does not have a formal moniker. “It doesn’t have a name.” Dr, Vikoren hinted a name is forthcoming.
GETTING PATIENTS BETTER PREPARED REDUCES NEED FOR PAIN MEDICINE
Dr. Vikoren talked about how he and his team have come up with new ways to help a patient's outlook as the day of surgery approaches, and without the need for the use of opioids at all with their replacement surgery.
“Some of the things that make this process successful are people doing pre-surgery therapy designed to strengthen their muscles,” Dr. Vikoren said. “They take a tour of the center to have an ease of their mindset on what to expect the day of the surgery. It really helps people feel less pain, if there is less anxiety.”
He talked about the methods he and his team use to minimize opioids for pain treatment.
“What we do is that we, first, do pre-surgery medication with anti-inflammatory medications. It’s like wearing earplugs to a concert so your ears won’t ring on the way home. You can still hear the music but your ears won’t ring later. So when we do pre-surgery, non-narcotic pre-medication, it actually makes it so you never reach that threshold where the pain takes a life of its own.
“Then during the surgery, we normally do a spinal anesthetic, where the legs are numb and the people are sedated so they don’t hear anything, but they are not on a breathing machine.”
Dr. Vikoren continued.
"After the surgery concludes and the part is in, I inject around the knee or the hip with local anesthetic to numb it. Our anesthesiologist also does a nerve block. He does the nerve block when the legs are still numb in the recovery room so people aren’t bothered by that. That provides and additional 24 to 48 hours of pain control.
“The average patient here does not require any opioids, period,” Dr. Vikoren said. “Not even one injection of opioids the whole time they are here.”
Dr. Vikoren said opioids may have a place after surgery, but he says it is minimal.
“We may prescribe a small supply for home in case there is a problem,” he said. “The main focus is on pain control with anti-inflammatories, Tylenol, ice, nerve block etc. Not so much opioids.”
Communities everywhere are filled with stories of people who became addicted to pain medicine after surgery and could not stop or get help. Too many of those stories ended in tragedy. Dr. Vikoran, and the rest of the orthopedic community hope these upgrades in the treatment of pain is a road to having an impact on the opioid epidemic.
WHAT HAPPENS AFTER SURGERY?
Dr. Vikoren’s one-day program that gets patients in and out of his facility in one day is working. But has the time it takes to resume normal activity been reduced as well?
“What our protocol is, and this is the protocol that was approved by the State of Pennsylvania,” Dr. Vikoren explained. “You have surgery at 7:30 AM, finish at 8:30 AM, spinal wears off at 9:30 AM, you start your therapy. During your therapy you do steps, everything. You’re done by 11:00 AM. You go home where we have a physical therapist and a nurse meet the patient at the house for therapy later in the day at the house, helping with any pain control issues or answer any questions that might come up.”
Dr. Vikoren said the nurse and therapist return the next day for more therapy. After that, the doctor said patients make visits to their physical therapy office.
According to Dr. Vikoren, seniors can now use Medicare for same-day surgery. But it has to be done at the hospital.
So most of his patients are under 65. Dr. Vikoren said Blue Shield is working with them right now and he hopes to get expanded coverage from them and other insurance companies. Call the office for all insurance and financial information Dr. Vikoren’s practice offers.
It appears that Dr. Vikoren and his team at the Bucks County Surgical Suites have left no stone unturned, and he took all the time he needed to do it.*
NOTE: The address and contact information for Bucks County Surgical Suites:
2800 Kelly Road, Suite 100, Warrington, PA 18976-3626. Phone # 215-607-2100
Follow Al Thompson on Twitter @thompsoniii