after surgery:

Recovery suites model takes root in Las Vegas

Idea is to create comfortable environment for patients

Courtesy image

Dr. Michael Crovetti, right, talks with a patient using Secure Track to walk following surgery. A day after hip surgery, patients walk an average of 998 feet, and 706 feet after knee surgery.

Terry Davis just walked 480 feet.

It may not sound like much, but the fact that he did it only two hours after having his hip replaced makes for quite an achievement. Resting in a chair after the feat, Davis says life is already more hopeful than it has been for the past 25 years.

For him, pain was simply part of everyday living. A 1987 car accident that ejected him from his Ford Mustang left him feeling lucky to be alive. But a degenerating hip whose pain seemed to explode after the age of 30, causing many sleepless nights and a hobbled gait, were doing more than slowing the 46-year-old.

“I used to always walk with a limp and people would ask, ‘Why are you limping?’ I didn’t really know what to say,” he added.

While only a few hours after surgery Davis isn’t pain-free — and staff at Coronado Surgical Recovery Suites has warned him that day two will have plenty of pain to endure — Davis’ optimism shines. He hopes to be back running his pest control company within three weeks.

The Henderson native chose Dr. Michael Crovetti, owner of Crovetti Orthopedics and Coronado Surgical Recovery Suites, in Henderson, for his hip replacement. Crovetti has replaced thousands of knees, hips and shoulders since starting his local practice in 1999. But more important to his patients is his approach to recovery and those crucial days following surgery.

Coronado Surgical Recovery Suites is a model Crovetti wants reproduced across the country. It’s the reason people like Davis are up and well on their way to pain-free living so quickly, Crovetti says. He speaks of Mayo Clinic, Johns Hopkins and Scripps, when it comes to the standards he wants in place for other recovery suites nationwide.

“What makes those places so great? You know exactly what you’re getting when you go there,” he said.

What it is

The surgical recovery suites concept doesn’t sound groundbreaking. The idea behind it is to simply create a comfortable environment for patients so they can start moving and rehabilitating their replaced joints and hips as quickly as possible after surgery. The surgery suites, staffed with energetic nurses and physical therapists to assist patients, are located in the same building as the operating room.

After recovery, patients are wheeled to a private suite, where they spend the next two days learning to regain their physical abilities with the help of family and staff. The earth-toned rooms have wood flooring. Patients sleep in a Murphy bed and have a bathroom with walk-in shower. The bed is folded up after breakfast, as patients are encouraged to move. Food is brought in from either nearby restaurants or an on-site deli. Patients stay for two days after the surgery; a family member stays with them, learning what’s needed for care after discharge.

“They (the family member) know exactly what to do when they leave,” Crovetti adds.

Key to recovery, patients are aided by a ceiling-mounted stabilization device known as Secure Track. Patients can put as little or as much weight on the system as needed. With the help of a physical therapist and the device, which replaces traditional metal frame walkers, they are guided up and down a 50-foot-long hallway, its floor painted green with football yard line markings and touchdown goal posts on each end.

“I don’t care where you live in the world. You know when someone scores a touchdown, it’s a good thing. I want people to score a lot of touchdowns,” said Crovetti, a one-time college quarterback.

The surgeon almost downplays his own world-class abilities. He has lectured internationally about his techniques. Particularly when it comes to hip replacements, his methods use a much smaller incision and disturb less tissue overall. Crovetti is an admitted control freak about his operating room routine; he has used the same two anesthesiologists for years.

“When these guys go on vacation, I’m on vacation,” he said.

His surgeries run on reassuring autopilot. Everyone knows exactly what’s expected of them in the operating room, and the goal, Crovetti asserts, goes far beyond simply replacing the hip, knee or shoulder. It’s about restoring complete physical ability without ongoing pain. And the only way to do that, he believes, is to get the patients moving.

There are no mandates on how far a person must walk. But the environment brings plenty of encouragement. An upbeat Crovetti, nurses and physical therapists seem to spend as much time high-fiving patients as they do providing care. The average number of feet walked for Crovetti’s first 150 patients using the suites is 356 feet on the surgery day for hip replacements and 310 feet for knee replacements.

Day one following the operation, hip patients average 998 feet walked and knee patients 706 feet. In a hospital, it is common to only walk about 250 feet total, he notes. The movement also prevents blood clots and embolisms, common problems after the surgeries.

Medical tourism

It comes across as odd to many that a medical practice like the surgery recovery suites is coming out of the Las Vegas Valley, an area playing catch-up in the economic diversity department and routinely thrashed nationally for its many problems. Crovetti is armed with 200-plus satisfied patients and ongoing data collection supporting his concept.

The model is getting its share of word-of-mouth activity, and people like Trish Padilla, a paralegal living in Albuquerque, are seeking Crovetti out. Padilla, an avid biker, had a fall about five years ago that made it difficult for her to walk long distances.

When seeking advice from past hip replacement patients in her area, Padilla wasn’t impressed with what she heard. Long recoveries and spotty pain reduction stories weren’t reassuring. A friend living in Henderson referred her to Crovetti and, coincidentally, the surgeon she was considering in Albuquerque actually ended up relocating to Henderson to join Crovetti’s practice.

Helping his case with referrals, Crovetti also said the surgeries and movement afterward come with a dramatic and quick reduction in pain. Pain scores usually come in at 9 or 10 (on a 10-point scale, 10 being the highest) prior to surgery and are cut in half after surgery and are minimal by three weeks.

Within a few months of her operation, Padilla’s pain level is nonexistent. She has enjoyed 30-mile bike rides and routinely does 12- and 13-mile rides on back-to-back days as well.

“I tell people I have a bionic hip,” she said with a laugh.

Expansion

In a world where almost all of these surgeries are still done in hospitals, with little or no dedicated space for patient mobility, the idea has met some resistance. Simply getting his site licensed by the state required testimonies, hearings and a long run of paperwork with state officials to prove it could work.

He received clearance from health examiners in November 2010. He describes a system “that didn’t understand the model,” but whose oversight and concerns were well meaning and required.

“I’m telling you, the way they are looking so closely at things, it all points to a state that really wants to get better,” Crovetti added.

What seems to be pushing the recovery suite model forward is Crovetti’s team’s data collection for the past year and a half. Patients sign forms indicating their progress will be used for data collection to see how the model is working or where changes need to be made. Crovetti has more than 200 surgeries done under the model and the same number of satisfied customers providing referrals.

“The biggest reason companies fail with stuff like this is a lack of data,” he explained.

With a lot of legwork behind him and each new patient an opportunity to add to his proof of a better way to deliver medical care, Crovetti is more than optimistic about the future. Now the challenge is finding physicians willing to commit to the concept.

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  1. I just had a total knee replacement, and believe me, after surgery exercise and therapy is critical. I was lazy at first, and my surgeon was worried about my lack of progress. So I buckeld down, and went through 8 weeks of somewhat arduous every other day therapy. It worked, and now my new knee is better than my old one.