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.