Abstract
Perhaps the most significant developments in joint replacement surgery in the past decade have been in the area of multimodal peri-operative management reducing pain, nausea, and length of stay leading to outpatient joint replacement surgery with recovery at home. The surgical procedures included in the outpatient program have expanded from Partial Knee Arthroplasty to Primary TKA, Primary THA, and selected revision cases. Emerging data demonstrate safety, reduced cost, and reduced resources.
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, pre-operative education, efficient surgery, and a surgeon controlled environment with highly standardised care. This is a distinct shift in today's health care environment, which has seen the expansion of regulatory demands; focus on Electronic Health Records (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.
