Abstract
Refinement of surgical techniques, anesthesia protocols, and patient selection has facilitated this transformation to same day discharge for arthroplasty care, most notably Partial Knee Arthroplasty (PKA). The trend for early discharge has already happened for procedures formerly regarded as “inpatient” procedures such as upper extremity surgery, arthroscopy, ACL reconstruction, foot and ankle procedures, and rotator cuff repair. Our program began focused on PKA and has now expanded to primary TKA and THA, and select revision cases. Over the past few years we have performed 1,230 knee arthroplasty procedures with no readmissions for pain control. Average age and age range is identical to our inpatient cohort for our partial knee cases. Patient selection is based on medical screening criteria and insurance access. PKA is the ideal procedure to begin your transition to the outpatient space. We currently perform medial PKA, lateral PKA, and patellofemoral arthroplasty as an outpatient.
The program centers on the patient, their family, home recovery, preoperative education, efficient surgery, and represents a shift in the paradigm of arthroplasty care. It can be highly beneficial to patients, surgeons, anesthesia, facility costs, and payors as arthroplasty procedures shift to the outpatient space.
Perhaps the most significant developments in joint replacement surgery in the past decade have been in the area of multimodal pain management. This has reduced length of stay in the inpatient hospital environment opening the opportunity for cost savings and even outpatient joint replacement surgery for appropriately selected patients. The hallmark of this program is meticulous protocol execution. Preemptive pain control with oral anti-inflammatory agents, gabapentin, regional anesthetic blocks that preserve quad function for TKA (adductor canal block) and pericapsular long acting local anesthetics with the addition of injectable ketorolac and IV acetaminophen are key adjuncts. Over the past two years utilizing this type of program over 60% of our partial knee replacement patients are now returning home the day of surgery.
Concerns over readmission are appropriate. The rates of complications and readmissions are less than our inpatient cohort in appropriately selected cases with a standardised care map. We believe this brings the best VALUE to the patients, surgeons, and the arthroplasty system.
