Mass. General to bring orthopedics to suburbs

Massachusetts General Hospital plans to open its first suburban outpatient surgery center to ease its space crunch, and to serve a growing pool of patients seeking orthopedic procedures.

The center, scheduled to open next May, will be located in Waltham in the Mass. General West office building. Mass. General executives said operating rooms at the hospital's Boston campus are completely booked on a daily basis, limiting its growth potential. Orthopedic operations account for the largest single block of surgery time, about 30 percent. Some of those procedures will move to Waltham.

Mass. General, which will make an initial investment of about $10 million in the project, is one of several Massachusetts hospitals expanding orthopedics, a specialty that is experiencing a boom as the types of procedures available -- and the patients who want them -- increase. Doctors and healthcare executives said the growth can be partly attributed to the development of less-invasive surgical techniques, which allow doctors to operate on patients who would have been considered too risky for surgery. They also make surgery more attractive to other patients.

Nationwide, the number of hospital stays for knee replacement surgeries alone grew to 400,000 in 2002, an increase of more than 40 percent over four years, according to the most recent data from the American Academy of Orthopedic Surgeons.

New England Baptist Hospital in Boston, which performs mostly orthopedic surgery, is so crowded that its executives have asked the City of Boston to approve an expansion plan that includes a wing with four operating rooms and a 72,000-square-foot office building for doctors. The hospital currently has 13 operating rooms.

Starting this month, New England Baptist also will schedule orthopedic surgery for overnight patients one Saturday each month to help decrease the three- to six-month wait. The number of orthopedic patients at New England Baptist between 2003 and 2004 grew 14 percent, to 5,141.

Caritas St. Elizabeth's Medical Center in Brighton has invested about $4 million to renovate its ninth floor for a multidisciplinary Bone and Joint Center headed by former Red Sox physician Dr. William Morgan, he said. The hospital has been advertising the center heavily on sports radio station WEEI-AM.

At many hospitals, orthopedic surgery is one of the more profitable services. To capitalize, some surgeons have opened their own outpatient surgery centers, which hospital executives fear drains revenue at their institutions.

''It's a very competitive market; all you have to do is drive into work in the morning and listen to the ads on the radio," said Dr. Harry Rubash, chief of orthopedics at Mass. General.

Rubash said one reason to focus on orthopedics at the Waltham surgery center is that more of the procedures are being performed on an outpatient basis because of less-invasive surgical techniques. Fifty-five percent of Mass. General's orthopedic patients -- about 5,200 last year -- now go home the same day as their surgery. The hospital had about 4,300 overnight orthopedic surgery patients last year. Rubash expects the percentage of outpatient cases to grow to 60 percent this year.

In the last five years, the number of orthopedic surgery cases at Mass. General has grown by 15 percent, Rubash said, though he would not release the numbers of surgeries for past years.

Ann Prestipino, Mass. General senior vice president for surgical and anesthesia services and clinical business development, said the success of the Waltham center hinges on whether enough surgeons are willing to use it. They are not mandated to do so, but Prestipino said the hospital has been through ''months of consensus building. I am very confident that the doctors who said they will go, will go," she said. New England Baptist faces a similar question: Orthopedic surgeons are not required to operate on Saturdays.

David Gaynor, administrative director for orthopedics at Mass. General, said that of the 30 active orthopedic surgeons, so far about 10 have agreed to move some of their cases to Waltham. Most of them already perform a large number of outpatient operations, Gaynor said.

The Waltham center's four operating rooms each will be able to handle 1,000 to 1,200 surgeries annually. Rubash said surgeons there will perform mostly ''soft-tissue" procedures such as hand surgery for carpal tunnel syndrome, foot and ankle surgery, and knee and shoulder arthroscopy. Surgeons will continue to perform joint replacements in Boston, he said.

It remains to be determined whether patients will be eager to undergo surgery outside of the hospital's main campus. Mass. General executives said they will promote the center as being more convenient for people living in Boston's western suburbs. They also plan to highlight the availability of parking and the center's less-hectic environment.

Hospital executives said they expect to be able to move patients through the surgery process more quickly than in the city, because procedures won't be disrupted by emergencies and more complex operations, the lengths of which are harder to predict.

Liz Kowalczyk can be reached at kowalczyk@globe.com.