complications final 2013
TRANSCRIPT
SRS – VERSION 8 UPGRADE
April, 2012
Complications of Shoulder Arthroscopy
Christopher M. Aland MD
Rothman Institute, Newtown, Pa
Disclaimer
• I own stock in Arthrocare, and Johnson and Johnson
• I am on the membership committee of AANA• I have no conflicts of interest that affect my
ability to teach this course
Introduction
While rates are low, complications do occur. Awareness is the best preventative measurePre-op factorsIntra-op factorsPost op factors
Pre op factors
• Misdiagnosis• Pre op stiffness• Pumps Patient factors
Misdiagnosis
• Is it really shoulder pain?• Will your procedure address the diagnosis
Stiffness
• Pre-op pain may lead to secondary capsulitis• Treatment of capsulitis may run counter to
intended procedure
Patient factors
• Age• Obesity• Cigarettes• History of MRSA• History of DVT
Intra-op factors
• Nerve damage• Vascular injury– direct– indirect
• Hardware related• Patient positioning• Thermal• Fluids• Rare and unusual
Nerve damage
• Usually transient, permanent may occur• Most common are axillary and
musculocutaneous• Portal placement is important• Do you know where your equipment is?• Patient positioning
Vascular
• Fortunately very rare, but can occur with portal placement
• In general, vessels 2cm away• Anterior portal: axillary artery, cephalic vein• Posterior portal: suprascapular artery• Superior portal: suprascapular artery• The dreaded red-out
Hardware/equipment
• Anchors• Hand instruments• Shavers• Wands• What the salesman dragged in
Patient positioning
• Balanced suspension• Head and neck position• Leg and thigh
Thermal issues
• Chondrolysis• Hot water skin burns• Role of capsular shrinkage• Axillary roll
Fluids
• Most visibly impressive, but least worrisome– Unless you slip and fall
• May obscure landmarks• Pain• Transient neurological issues• Excess usage/appropriate procedure
Rare and unusual
• Air embolism• Acromial fractures• Carotid artery compression• RSD
Post-Op factors
• Stiffness• Infection• Chondrolysis• Pain• DVT
Stiffness
Most common complicationDebate re: early v. late Physical Therapy
Infection
• Very rare• Role of propionobacterium acne
Chondrolysis
• Role of pain pumps/local anesthetics• Thermal issues• Idiopathic
Pain
• Usual pain• Unusual pain
DVT
• Very rare• Should have routine measures, ie: SCDs• High risk patients
Conclusion
• Consider how your pre-op work up will have an impact on your surgery
• Education as to patient factors, equipment• Monitor post op status
Thank-you
Version 8
• Version 8 of SRS provides us with the upgraded software that will allow the organization to collect the required data for meaningful use.
• This version will be live in all areas of the RI on April 23, 2012.
Has anything changed?
• There are several true “upgrades” to items that we use today.
• There are many new features that are required for meaningful use.
• There is one feature that has been removed.
New Features
• An “on the fly” selection of a date of service in the chart list
• Viewing multiple providers in one chart list• Pharmacy is in view within the clinical summary • Past and future appointments are in view within
the clinical summary• Rx favorite list now allows providers to save their
SIG in their favorites and also to a master file.
What was removed?
The additional referring provider will no longer be available with in the summary screen.
• The process will remain the same for adding additional providers to the patient’s chart.
• That information will now only be viewed in the same area/tab that is accessed to add an additional provider.