Site of service for vertebral augmentation?

[tmvguy03]

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For those who perform vertebral augmentation: do you perform hospital based/ASC/ in office?

 

[BobBarker]

If you have your own practice you need to do it in your office.

 

[callmeanesthesia]

If you have your own practice you need to do it in your office.

We have all MAs, no nurses, and don’t do IV sedation. Doesn’t bother me to do it with oral sedation and lots of local but I’d probably have to start the IV myself for antibiotics. We only have chairs to recover in, so I’d have to load them in a wheelchair and then go lay them down in a clinic room for the cement to harden. Would love to be able to do it in office though. Think I could make it work?

 

[lobelsteve]

80/20 in office vs hospital. Much more efficient in office. Local only. Can give them Rx for Ativan 1mg #2 if they desire.

 

[callmeanesthesia]

80/20 in office vs hospital. Much more efficient in office. Local only. Can give them Rx for Ativan 1mg #2 if they desire.

May I ask what you do for antibiotics?

 

[lobelsteve]

May I ask what you do for antibiotics?

IV Ancef 2gm or Clinda 600.
If no one around to start IV or meds not readily available, 1G Rocephin IM. This is rare. My office has 20 docs, urgent care, an infusion hallway, in house RPh.

 

[emd123]

For those who perform vertebral augmentation: do you perform hospital based/ASC/ in office?

In office.

 

[emd123]

IV Ancef 2gm or Clinda 600.
If no one around to start IV or meds not readily available, 1G Rocephin IM. This is rare. My office has 20 docs, urgent care, an infusion hallway, in house RPh.

Can give the Ancef IM also

 

[emd123]

We have all MAs, no nurses, and don’t do IV sedation. Doesn’t bother me to do it with oral sedation and lots of local but I’d probably have to start the IV myself for antibiotics. We only have chairs to recover in, so I’d have to load them in a wheelchair and then go lay them down in a clinic room for the cement to harden. Would love to be able to do it in office though. Think I could make it work?

I do kyphos in office.
I prescribe ahead of time, Xanax 0.5mg (if tiny, low tolerance) or 1mg (if bigger, superfreak anxious or tolerance), #2 tabs prescribed. Take 1-2 tab po 60 min prior to procedure. Nurse usually tells them to take one an hour before and bring the other to procedure and we'll have them take it if they don't seem mellow enough. Will also have them take 1 pain pill with it (either a tramadol, hydrocodone or oxycodone).
1 or 2 g cefazlin IM 30 min prior to procedure. Or cleocin.
I schedule these as my last case at 2 pm, so I have no hurry, can take lots of time with local and careful technique, ensuring adequate anxiolysis. You can't blast through them like you can when the patients are out. It pays well enough in office, you can leave a bunch of time.

Super sick people that insist on IV sedation, too sick to lay on stomach for a long time or otherwise not a chip-shot case, I have done by someone else at an ASC or hospital.

Knock on wood, but as of yet I've never had to abort one of these due to under sedation. I've also never had anyone go south on me except someone who had a persistently low O2 sat after the procedure. She was fine, but just couldn't keep her sat up enough to go home in a car. Just kept her on O2 per nasal cannula and sent her to the ED as a precaution. In the ED she admitted to taking extra pain medicine prior to the procedure, in addition to what I gave her for the procedure, due to anxiety. She did fine.

 

[drusso]

How long do people insurance will keep paying for it? There's just less and less meat on the bones to pay for interventional pain management service. The rationing will begin...probably do well as a cash service line which will favor office-based SOS.

Vertebroplasty for vertebral compression fractures: Placebo or effective?

 

[lobelsteve]

How long do people insurance will keep paying for it? There's just less and less meat on the bones to pay for interventional pain management service. The rationing will begin...probably do well as a cash service line which will favor office-based SOS.

Vertebroplasty for vertebral compression fractures: Placebo or effective?

That article is disproven nonsense and was based on the two studies penned by kallmes. So many flaws in design and execution as to be not worthy of publication. Debunked by sis and nass. Stop paying for mushu.

 

[drusso]

That article is disproven nonsense and was based on the two studies penned by kallmes. So many flaws in design and execution as to be not worthy of publication. Debunked by sis and nass. Stop paying for mushu.

I like to post it because it annoys you...🙂

 

[emd123]

How long do people insurance will keep paying for it? There's just less and less meat on the bones to pay for interventional pain management service. The rationing will begin...probably do well as a cash service line which will favor office-based SOS.

Vertebroplasty for vertebral compression fractures: Placebo or effective?

I don't believe that study

 

[drusso]

I don't believe that study

I believe that you don't believe and that's almost like not believing...

 

[Ducttape]

its okay not to believe a meta-analysis.

if however this information is directly from a high quality study, then one should go through the process of disproving the study with a different study

 

[emd123]

its okay not to believe a meta-analysis.

if however this information is directly from a high quality study, then one should go through the process of disproving the study with a different study

You mean I can't just overwhelm that with opinion on the internet?

 

[lobelsteve]

its okay not to believe a meta-analysis.

if however this information is directly from a high quality study, then one should go through the process of disproving the study with a different study

This was not a study, it was a biased review of prior studies that did not consider the flaws of the studies.

 

[Doctodd]

I like to post it because it annoys you...🙂

Einstein doesnt like to be annoyed

 

[clubdeac]

So I'm going to start doing these at my new hospital and I noticed that one of my VCF referrals went to IR. I was pissed and went into her chart to see what had happened. Turns out she coded on the table in the middle of the procedure. They had to flip her over and hook up the AED! Sounds like she's ok but damn!! So glad that wasn't my first kypho at the new place. It probably would've been my last!

 

[callmeanesthesia]

So I'm going to start doing these at my new hospital and I noticed that one of my VCF referrals went to IR. I was pissed and went into her chart to see what had happened. Turns out she coded on the table in the middle of the procedure. They had to flip her over and hook up the AED! Sounds like she's ok but damn!! So glad that wasn't my first kypho at the new place. It probably would've been my last!

You don’t just code for no reason though. Probably either cement embolus or they oversedated her and she got severely hypercapneic.