Outpatient joint replacement surgery benefits everyone involved

In recent years, physician research has shown that outpatient joint replacement surgery benefits everyone involved – from the patients to the physians and clinicians. Patients recover better when they return home after surgery, instead of staying in the hospital or a rehabilitation facility. Below is a summary of the data that Dr. Berend and his SurgCenter Development colleagues from across the country have developed about the benefits of outpatient surgery:

Post-Acute Care After TJA: There is No Place Like Home

Perhaps the most significant developments in joint replacement surgery in the past decade have been in the area of multimodal perioperative management reducing pain, nausea, and length of stay leading to outpatient joint replacement surgery with recovery at home.^1,2,3 The surgical procedures included in the outpatient program have expanded from Partial Knee Arthroplasty to Primary TKA, Primary THA⁴, and selected revision cases. Emerging data demonstrate safety, reduced cost, and reduced resources.⁵

Since 2011 we helped develop and implement an outpatient program as part of 76 participating physician-owned ambulatory facilities in 19 states. 19,415 joint replacements have been performed. The cohort included 6,146 TKA, 5,102 THA, 7,227 partial knee replacements, and 940 revisions and TSA. Patients had a mean age of 58 years and 50% of the patients were female. 97% of patients were discharged same day, the deep infection rate was 0.2%, and the readmission rate was 0.3%.

The outpatient program centers on the patient needs, family engagement, essentials of home recovery, preoperative education, efficient surgery, and a surgeon controlled environment with highly standardized care. This is a distinct shift in today’s healthcare environment, which has seen the expansion of regulatory demands; focus on Electronic Health Record (EHR), and distractions from real discussions of demonstrated value creation. The future is bright for both ASC and hospital development of successful outpatient joint replacement program for patients and surgeons alike.

References

1. Lombardi AV Jr, Barrington JW, Berend KR, Berend ME, Dorr LD, Hamilton W, Hurst JM, Morris MJ, Scuderi GR. Outpatient Arthroplasty is Here Now. Instr Course Lect. 2016;65:531-46.
2. Berend ME, Berend KR, Lombardi AV Jr. Advances in pain management: game changers in knee arthroplasty. Bone Joint J. 2014 Nov;96-B(11 Supple A):7-9.
3. Berend, ME, Lackey, WG, Carter, JL. Outpatient TJA: “Drive-Thru” Surgery – Affirms, JBJS-B. CCJR proceedings.
4. Goyal N, Chen AF, Padgett SE, Tan TL, Kheir MM, Hopper RH Jr, Hamilton WG, Hozack WJ. Otto Aufranc Award: A Multicenter, Randomized Study of Outpatient versus Inpatient Total Hip Arthroplasty. Clin Orthop Relat Res. 2017 Feb;475(2):364-372.
5. Edwards, et al. Avoiding Readmsisions – Support Systems Required after Discharge to Continue Rapid Recovery. J Arthoplasty 2015.