flemmings | (no subject)

Oh, she says, getting cold feet, this is such a bad idea. Too late now. But our business co-ord called me today to tell me all the news. Her mother had a knee replacement fifteen years ago that never worked properly and now doesn't work at all, so she's back to St Mike's to see what's what, and she has a female surgeon! Angh. I want a female surgeon too!

C had kittens at the notion the Toronto Western will send knee surgery patients home the next day, never mind the same day. But I fancy procedures have changed in 15 years. For one thing, they no longer do general anesthetics for that operation. Epidural, nerve block, and sedation (from which, I am told, you can be roused by a loud noise, so mild sedation). Has the side effect of keeping you pain free for a while, which is good and certainly better than morphine which does nothing but make time pass veeeery slooowly.

C was also pushing for me to go to St Mike's, but since her mother's surgeon was such a loss, I was never that keen, even though I was referred to a different surgeon who was at that time the doyen of the profession. My nursing friend gave me the side eye when I was scheduled for there, which rather sorts with my own impressions of the place. Anyway, que será será.

Flat | Top-Level Comments Only

For what it’s worth, we’ve had to create a number of new procedure codes for knee (and hip, and shoulder) replacements over the last fifteen years or so, and I can definitely say it is an evolving field and consultants have come up with new ways of doing it which are clinically distinct from the previous (more basic) methods.

Good news to hear. Possibly not a simple outpatient procedure yet, but hopefully getting there.

The rise in arthroscopic procedures (minimal access rather than open) has also been very marked.

In order to satisfy growing clinical demand for arthroscopic procedure codes, we ended up creating a new code "Y76.7 Arthroscopic approach to joint" together with guidance that said, basically, "if you're doing an arthroscopic procedure and there isn't a code for it, but there is a code for it as an open procedure, then use the open procedure code together with Y76.7 to indicate that it was performed arthroscopically".

(blinks) (refrains from responding 'whatever you say, dear') All I know about arthroscopy is that the experts were pooh-poohing it as ineffective not that long ago, I suspect because surgeons really really like cutting things open and sulk when they can't. Evidently saner heads prevailed, if you had to make a new code for it.

It's part of the whole "insert X-scope through narrow incision / natural orifice to do operation, rather than doing it as an open operation where you cut open the affected area" concept - which has been taking ever increasing steps forward over the last dozen years. Gastroscope (stomach), rhinoscope (nose), colonoscope (colon, and heaven preserve me from that one), etc - "arthroscopy" just means inserting an endoscope into a joint, looking through it to see what's going on and doing the operation with minimal acess that way, though in that case you do need to make a small incision, owing to the lack of natural orifices in joints.

I was about to add "periscope" to that list, but you don't use _those_ inside the body . . .