Orthopedic Surgery has often been considered a largely inpatient specialty due to the common association of this field with major reconstructions, such as hip and knee replacement. Since this process can require several days of hospitalization, patients seeking major joint replacement surgery or spinal surgery from the United States have often traveled abroad in order to control the associated costs.

Ambulatory orthopedic surgical procedures in the realm of medical tourism have been rarely discussed, particularly in the context of so-called “Inbound Medical Tourism” or “Reverse Medical Tourism”. This is largely due to lack of public awareness, even amongst medical professionals, as to what type of procedures are possible in bone and joint surgery, and the increasing feasibility of performing many of these surgeries on an ambulatory and/or traveling basis.

The advent of minimally invasive surgery, such as arthroscopy, coupled with superior regional block anesthesia, has allowed traditionally major surgery to be comfortably performed in specialized ambulatory centers. This has benefitted domestic patients, and now, increasing numbers of international patients are traveling into the United States seeking high-level, innovative technologies or procedures that may not be available to them in their home countries. Furthermore, the use of post-operative pain pump analgesia, has allowed major surgeries to be performed with minimal to no post-operative pain, broadening the scope of surgeries that can be offered to the traveling patient. For example, Arthroscopic Shoulder Surgery can be done via an interscalene block, followed by pain pump catheter delivery of anesthetic, allowing shoulder rotator cuff surgery, or even internal fixation of major fractures to be safely, and painlessly, performed on an outpatient basis.

The International Orthopedic Group, based in Doral, Florida, located minutes from Miami International Airport, has been performing many of these surgeries on inbound medical tourist patients for several years with great success. The patient typically arrives on a Monday, often coming straight from the nearby airport via limousine service, and has all diagnostic studies at the time.  They are evaluated by the Orthopedic Sub-Specialist. For example, a patient with wrist or shoulder pain would have a thorough physical exam during discussion with the orthopedic hand specialist, at Badia Hand to Shoulder Center, followed by fluoroscopic evaluation after digital radiographs are taken. If necessary, MRI imaging in an open magnet extremity machine might then be performed during the same visit with the surgeon directly explaining his needs to the imaging technician specialist. The results are immediately shown to the patient on a moniter in their exam room, coupled with an explanation by the surgeon and demonstration of patient education materials to explain the medical problem, even illustrating the surgery using an animated video or drawings.

The very next morning, the patient undergoes the procedure, say the wrist or shoulder arthroscopic repair, at the Surgery Center at Doral, a 3 room federally certified ambulatory surgical facility. This includes 3 operating rooms, state-of-the-art arthroscopic equipment, and a family waiting room where updates are continuously delivered via plasma moniter, which also presents patient educational material. Any medical clearances are performed the night before at OrthoNOW, an immediate orthopedic care center which includes a family practice physician who evaluates the patients. Major surgeries are safely performed, evaluated by the cardiac anesthesiologist and well trained specialists to avoid complications. Nevertheless, virtually all surgeries are performed via regional block anesthesia and sedation which minimizes issues related to general anesthesia. Patients are often taken to the hotel, located 200 meters away, often accompanied by the recovery room nursing staff.

Most post-operative visits are done within 2-5 days, allowing follow-up xrays, patient and family questions addressed, and the subsequent treatment, including rehabilitation discussed at length. In many cases, the patient begins the rehab process at Integra, the inhouse rehabilitation center directed by a Physiatrist Physician, working closely with occupational and physical therapists.

IOG has far-reaching relationships with rehab specialists and Physical Therapists in multiple countries that facilitate post-operative management, the rehabilitation process and furthermore insure continuity of care. Integra team specialists will often communicate with the therapist abroad to ensure adherence to the protocol. The international patient coordinator directly addresses any questions, or concerns, before and after treatment, including travel logistics and arrangements. The vibrant Doral area has ample restaurants and entertainment options with a several kilometer area, including golf and tennis resorts, spas, and world-class shopping malls to allow family members to enjoy this time and their experience away from home.

Orthopedic and musculoskeletal issues can almost all be addressed in a single multi-disciplinary center that does not have the cost and hassle of major hospital enviroments. The International Orthopedic Group works within OrthoNOW and Badia Hand to Shoulder Center to facilitate this process, beginning to end. Patients can benefit from all diagnostic, therapeutic and rehabilitative procedures under one roof. Advances in minimally invasive surgical techniques, coupled with regional block anesthetic techniques allow international orthopedic patients to enjoy the same treatments traditionally performed in tertiary hospitals in a more customized and convenient fashion and often ensure superior outcomes.

Reference:

Badia, A.  “A Growing Trend: Reverse Medical Tourism in South Florida” Commentary published in South Florida Hospital News, November 2007.

www.Hospitalnews.org

About the Author

Alejandro Badia, MD, FACS is a hand and upper extremity surgeon, Chief of Hand Surgery at Baptist Hospital in Miami and a member of the ASSH, AAHS, AAOS as well as Honorary Member of many International Hand Surgery Societies. Dr. Badia studied Physiology at Cornell University and obtained his Medical Degree at NYU, where he also trained in Orthopedics. A hand fellowship at Alleghany General Hospital in Pittsburgh was followed by an AO Trauma Fellowship in Freiburg, Germany. He runs an active International Hand Fellowship and serves on the Editorial Board of two hand journals.

Dr. Badia organizes a yearly Miami meeting for surgeons and therapists, devoted to Upper Limb Arthroscopy and Arthroplasty. In 2005 Dr. Badia co-founded the Miami Anatomical Research Center ( M.A.R.C. ), the largest surgical cadaveric training lab in the world.

In 2008, he completed the Badia Hand to Shoulder Center, a fully integrated clinical facility for the upper limb encompassing digital radiography, MRI extremity imaging, Integra rehabilitation facility and the Surgery Center at Doral. More recently, Dr. Badia inaugurated OrthoNOW, the first immediate orthopedic care center in south Florida which is staffed by surgeons from the International Orthopedic Group (IOG), a group of surgeons from lower extremity, upper limb and spine subspecialties who also treat elective orthopedic problems in international patients.

For more information, please visit www.drbadia.com, a patient education portal and website for hand surgeon academic exchange, via (305) 227-HAND at the Badia Hand to Shoulder Center or at OrthoNOW, (305) 537-7272
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