Possible outpatient surgery option with Dr. Gross

[bosoxgordon]

Hello all,
Well I think I am finally at the point where I am ready to pull the trigger and schedule my HSR surgery. I visited with Dr. Gross last year and after meeting with him, doing all my research, and talking with a few of you that have been treated by him, I'm sure he is the man for the job. The only question I had was when was the right time. Being a relatively young man (40) I have been hesitant to get the surgery. However, my pain levels have gone up over the last year and I have basically adopted a sedentary lifestyle. I have an appointment with Dr. Gross next week for updated x-rays and consult before scheduling surgery.
I would appreciate any feedback or experiences group members have that may be helpful to someone in my position. I also want to let the group know that apparently Dr. Gross now offers for selected patients an outpatient option for the HSR surgery. It involves having the surgery in the morning and then staying at a nearby hotel for recovery with visits from some nurses and Dr. Gross. Apparently they have done this with 17 patients so far with good results. Obviously they are very selective with which patients they offer this to.  I was very surprised that this was even an option. I was wondering if anyone out here has done this or even heard of this option. I don't have all the details yet but I suspect it would be a cheaper option. I would also suspect that I would get a better nights sleep in the hotel versus the hospital.
Does anyone have any thoughts or feedback on this?

[hernanu]

Hi Scott, I'm glad you've gotten to the point of getting rid of the pain. I guess the time for a resurfacing to me is not by chronological age, although that is a consideration, but in whether the OA is robbing you of your love of life.

There's no plus to me in suffering through the diminution of your life. A resurfacing will get you back on your feet. We all live with the possibility of a revision, but with good luck it will last for a long time. In the meanwhile, you'll live.

As far as the wait in the hospital or out, the time in the hospital for me was so quick (three days the first time, two the second), that I was quickly back home anyways. I think either way sounds good.

[Pat Walter]

Dr. Gross was going to wait until he had completed 100 outpatient hip resurfacings to publically announce it.  Lee Webb, however, said it was OK for me to mention it.  They feel it is very practical and that the patients really like going to the hotel instead of staying in the hospital.  It will be interesting to see how outpatient surgery works out.

Pat

[bosoxgordon]

Well shoot. I didn't mean to break the news too early. I didn't realize it was still in the trial period. I do have to say that I'm sure I would sleep much better in a hotel. When my wife and I had our son I stayed in the room that first night and with someone coming in every hour turning on the lights and waking up the baby it was like some sort of medieval torture.

[Dee Dee]

  If you have Cadillac insurance then I would stay at the hospital.  It is major surgery.  My out of pocket cost was $1000 plus a few small co-pays and hotel, food and gas.  Since they were done in the same year, my second surgery will cost me nearly nothing but the travel.


On the other hand, if you do not have good insurance, then outpatient would save so much.  I probably would not fit their profile for out patient candidate as I am overweight and take BP meds.

I thought of a few practical issues.
Are they using a hospital bed in the hotel?  I would really want that. 

I imagine your care giver will need to do most of what the nurses and hospital support teamwork do like getting you lots of drinks( I was sooo thirsty), changing the ice in the polar care unit, and keep track of and give you meds at the right time. (That might be an advantage because sometimes the staff were slow at getting to me especially at shift change)

My hubby stayed at a hotel to get some real sleep. He had a long drive home and a lot of responsibilities taking care of me when we got back.  I don't know if he would want the responsibility of caring for my immediate recovery in the hotel.

No one really likes hospital food, but how do you eat at the hotel.  I would not want my hubby to leave me alone.  So I m guessing the chosen hotel has a restaurant or your caregiver orders delivery.

I needed a pain shot the first night after both operations. I suppose there is a plan for that.
On check out day, I was feeling great and went to PT in the hospital to practice stairs again then proceeded to faint. Glad I was at the hospital.

Out patient sounds like a great idea for the right candidate who can't afford the hospital stay. 

Just my thoughts. 

Dee 

[obxpelican]

I have one thing to add to this discussion, although I've never read of an infection in that hospital you are far more likely to get an infection, especially the ones that are hard to kill in a hospital.  So basically you are probably better off not staying too long in the hospital.

Do they rehab at the hotel too?


Chuck

[bosoxgordon]

I don't have all the details yet. I will know more next week after I meet with the doctor and have a chance to talk with the staff about it. Of course my first question was "what is the advantage of this?" and I got the response alluding to the hazards of infection in a hospital, however I'm not sure how much of a problem this is at this particular hospital. I know hospitals can be a breeding ground for some exotic pathogens, but hotels aren't exactly pristine either. Don't ever go into a hotel room with a black light you'll never want to sleep there again. :-)
I would suspect the main benefit would be financial for someone that has to pay a larger portion of the costs out of pocket. Like I said I will know more after next week and if the folks out here are interested I can share what I learn with the group.
Thanks again for all the great feedback from all the good folks out here. The information and stories I've read out here over the last year have been a huge help to me in making this decision. It is still amazing to me that strangers would take valuable time out of their day to help another stranger in need. I hope I can "pay it forward" some day.

[Dan L]

Welcome.

My 2 cents is I would not stay anywhere other than the hospital, it is major surgery, and any unanticipated issues that may arise would be much easier to deal with in a hospital setting.  With that beign said, infection is a risk in the hospital, not sure what that risk would be in a hotel. but given what people do in hotels, that would also make me nervous.

With a DR as experienced as yours, and your life getting more sedentary, given all the data and anecdotal but consistent stories here about how well this goes, I would not wait if I were you.  I had mine at 51, had I done this 3-4 years ago, I would have avoided much suffering.

Best regards,

Dan

[Pat Walter]

The only thing I can think of is that the hospital is just across the street if there were problems.  I think Dr. Gross has thought this out well. In Belgium there was a nurse on call and the PT came to the hotel.  I know Dr. Gross and Lee Webb would not take any chances, so they obviously think this has many advantages.  I am sure we will learn more as time goes on - both how well patients like it and how well Dr. Gross likes this method.

Pat

[Bionic]

I had a bad reaction to the anesthesia after my HSR with Dr. Gross, causing my blood pressure to tank (to like 50/30).  I was grateful for a little time in the hospital.  I was actually fairly delirious for a day or so.

If you go for the outpatient option, just be sure to allow for a hospital stay in case the unexpected happens.

[Gino_Tortellini]

Bosox,
Knowing when the right time is a very personal decision. My time was Dec 3 & 5, 2012 at the age of 48 1/2. I went from overactive to sedentary in 4 years. Would not / could not walk the dog around the block. Now I am 5 weeks post Dr. Gross Bi Lateral and walking the dog again, wife holds the leash, ha!

You sound like you have one bad hip and not two? With two I was there M-F, one hip done on Mon and the other on Wed, flew home (14hr trip to PHX - hotel to doorstep; ice to ice) the following Sat, missed connection. I would not fly into Columbia again, drive 1+hr to/from Charlotte!

Dr. Gross has this procedure dialed. He knows who is a good Bi Lat candidate due to Age, BMI, Bone Density & general health. If he has a protocol for outpatient candidates I would trust that. Some things to ask would be what about the catheter, the IV, the meds AND the Bed! Having a adjustable bed helped getting comfortable. A caregiver would certainly be required to be present at the hotel for ICE and food and washroom help?

I would guess that a outpatient candidate would be first up at 8 AM and out of recovery and taking steps by 12-1. Out the door by six seems possible based on how I felt after that first one. Not likely after the second though, haha!

Not to change the direction of your thread but did Dr. Gross tell you that he is giving patients a choice in devices? I had to choose during my pre-op either the Biomet or Wright Conserve Plus with Biofoam.

G_T
Dr. Gross / Bi Lateral / Dec 03 & 05 2012
48 1/2 yrs

 

[John C]

I had the surgery with Dr Gross 4 1/2 years ago, and expect to have him do my other hip in the next few years. I am a fan of Dr Gross, Lee Webb, and the hospital. From my own experience, I would be a lot more comfortable staying in the hospital for at least one night. You can sometimes get pretty dizzy when getting up or doing PT during those first 24 hours, and it would seem like a good idea to have someone trained in how to catch/support you if that happened. I had a late in the day surgery the first time, and was in the hospital for two nights, and then stayed in the hotel two blocks away for two more nights before flying home, just to make sure everything was okay before leaving. As far as I know, the hotel across the parking lot from the hospital just has hotel rooms, whereas the one a couple of blocks away has suites with full kitchens and a living area separate from the bedroom.

[bosoxgordon]

I have an appointment with Dr. Gross next week and I'm sure ill have many more answers after that. I first found out I had a hip problem about 1.5 years ago. I went to several other orthopedic specialist that confirmed I had advanced OA in my left hip with FAI. Of course all those doctors also recommended a THR and did not speak highly of HSR. I'm sure that's a very similar story for many of you. I've been told my other hip will become symptomatic at some point in the future but so far it is doing fine. I have been reluctant to pull the trigger on the surgery simply because of my age and the possible limited life of the devices. Celebrex has bought me another year but it seems as though the pain has gotten worse over the last couple months and I can't avoid it any longer.
I share all this to say that the past year has given me a chance to do extensive research on this issue. I was even privileged to talk with a few Dr. Gross patients and learn from thier experiences. I won't recount everything I've learned since I'm sure most of you already knew what I was learning for the first time. After all of this research and interviews I am absolutely sure beyond any doubt that Dr. Gross is one of the best if not THE BEST HSR surgeon around.
I'm sure the outpatient option has been well thought out and if he recommends it, then it is safe. However, I know the great value of this website and the power of learning from the experience of others. I've never been through major surgery like this before and it helps to learn from others who have. Fortunately I only live 1.5 hours away from Columbia so I will be able to meet Dr. Gross in person and have many questions for him. If any of you want me to find something out let me know. I will try and share with the group as much as I can. Hopefully it will help anyone that is considering this option in the future.

[bosoxgordon]

Gino, I haven't gotten so far in the process to choose a device. To be honest I just always assumed I'd choose the Biomet cement less since that is the main one Dr. Gross uses. Which one did you choose and why?

[Gino_Tortellini]

Biomet.

[Miguelito]

I must say that this post flabbergasted me. Not sure I can quite get my head around it yet. I imagine I would be in the category of ideal candidate for this trial but not sure I would have gone for it last April (if it had been offered at the time of my surgery, which it wasn't). And I had my brother who is a cardiac nurse staying with me in the hotel room across the parking lot! And I could walk without a cane the day after surgery (a little that is, and I shouldn't have been doing that).

Frankly I need to think about this a lot more before I weigh in. Obviously Dr. Gross knows more about this surgery than I do, but on the other hand, I don't think he's actually gone through it either. He hasn't, has he? I am pretty sure I would want to stay at least one overnight. I could have gotten away without the second, but I have no strong objection to staying two nights.

Even a casual reading of my posts reveal that I am as big a fan of Dr. Gross as anyone on this website. That being said, he is quite upfront about his dissatisfaction with the third-party payment nature of our health care system, and his intent to not accept insurance (some types, all? I forget) once his practice no longer needs to. There was also some recent speculation on this website that perhaps that day is approaching. I imagine out-patient surgery would bring down the cost to someone not using insurance significantly, perhaps far enough that Dr. Gross could make the move to no longer accepting some or all insurance.

That being said I am sure Dr. Gross would not be doing this if it wasn't medically supported enough to at least make a trial (which is all that this appears to be). He is clearly interested in moving the practice of medicine forward, and he is very data oriented. If the trial supports continuing out-patient surgery, great. If it shows that tweaks are needed, great. If it is not a success, so be it.

I am of course just speculating about the insurance thing, but thought I would throw that out there for discussion.

Mike

[mslendzion]

How do they manage the pain?  Do you still get put on the IV?

[bosoxgordon]

I still don't have a lot of information. I will know a lot more after my appointment next week. I'm sure questions like this and others have all been thought out by Dr. Gross and his staff. Honestly the only reason I would consider it would be if the portion I have to pay is significantly lower for that option. It's all speculation at this point anyway until I have a chance to talk with him. I'm sure there is a benefit in savings for patients, but lets not be naive. I'm sure the genesis of this was so that Midlands Orthopedics can perform the procedures in their surgical suite and therefore capture the total global cost of the procedure and not have to contract out part of it to a hospital. Having said that, Dr. Gross and his team have an impeccable reputation and I have yet to find anything negative about him. I can trust his judgement while keeping in mind that money is always a major consideration in these matters.

[obxpelican]

Believe it or not, even when I got mine 4 + years ago many including me picked the Biomet cementless, this was even though it was pretty new, it just made sense to me to be honest with you.

All that said, Dr. Gross and a few other surgeons in this country could probably use most any device and it would turn out really well, this is all about picking a surgeon that has the talent, and this includes the recalled Depuy ASR, if that device is installed exactly right you will probably end up with a good result. 

Pick a quality surgeon you are going to get a quality result, personally I would let Gross put a rusty broom handle in me, I am confident he'll make it work   

Chuck

Gino, I haven't gotten so far in the process to choose a device. To be honest I just always assumed I'd choose the Biomet cement less since that is the main one Dr. Gross uses. Which one did you choose and why?

[bosoxgordon]

Chuck, Thanks for the response and the encouraging words about Dr. Gross and his work. Way back when I started this process of education and selection of a surgeon and device I was excited and a little worried that he was the only one using a cement-less device. I really was impressed with the long and established track record of the Birmingham system, but the more I learned about and listened to Dr. Gross the more I was impressed with his systematic reasoning. Intuitively the cement-less concept makes sense and the good doctor seems to be making it work well. I at least hope and pray so because I believe I am destine to have one of those little gems in my hip soon.