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Archive December 2019 XX, No. 12

Editor's Page: My Double Knee Replacement Saga

Is it still considered "outpatient" surgery if you spend a night in the hospital?

Dan O

Dan O'Connor, Editor-in-Chief


BOWED NO MORE My before-and-after X-rays.

Got both my knees replaced in late August — and both at the same time. Yes, I only had one surgery, one hospital stay and one course of rehabilitation, but the pain was just awful, and I needed help walking (cane and wheeled walker) and, ahem, sitting (shower chair and commode).

My recovery was longer and harder than I’d expected. I was out of work for 11 weeks, sidelined for 3 issues of Outpatient Surgery and our OR Excellence Conference in October. Due to a misunderstanding on my part, I got a late start on physical therapy, but the threat of manipulation under anesthesia kicked my PT into high gear.

As I write this 3 months post-op, I marvel at my before-and-after X-rays. My femur and tibia, bowlegged as croquet wickets in the pre-op film, are now as ramrod straight as football goal posts. An unexpected bonus: I’m a half-inch or so taller. My knee cartilage had totally worn down so that I was bone-on-bone, the end of my femur sitting precariously on my tibia. Not only did surgery straighten my legs out, but the implants created joint space where the cartilage used to be.

At my first clinic visit, I told my terrific surgeon, Eric B. Smith, MD, of the Rothman Orthopaedic Institute in Philadelphia, that I was editor of Outpatient Surgery. I even brought a copy of the magazine with me. No, he said, my surgery would not be “outpatient” because I wouldn’t be discharged the same day. That got me wondering how many others equated outpatient with same-day discharge. Yes, I spent a night in the surgical hospital where Dr. Smith performed my surgery and then a week at a rehabilitation hospital (with an ultra-sensitive bed alarm!), but my surgery was still an outpatient procedure. As alternate-site facilities such as surgical centers and surgical hospitals host more complex and invasive surgeries that require an overnight stay, we can no longer confine “outpatient surgery” to procedures with a same-day discharge.

I was also struck by the barrage of bills that came in the mail in the days and weeks after surgery. Everybody had their hand in my out-of-pocket: the surgeon, the surgical hospital, the orthopedic institute, the medical group and the anesthesia group, which failed to submit its charges to my insurer. I even owed the kindly psychologist who stopped in to see me at the rehab hospital a $22 copay. Here, I thought she was just being nice when she stopped by to chat. Thankfully, I didn’t get a bill for disabling my bed alarm with one good yank. OSM

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