Archive Orthopedic Surgery 2015

Inside Our Outpatient Total Joints Program

Sending patients home hours after knee or hip replacement is ortho's hottest trend.

Mark Gittins, DO

outpatient total joints TEAM EFFORT To succeed with outpatient total joints, numerous people have to know exactly what their jobs are, and they have to do those jobs consistently and well.

We've developed a comprehensive approach to outpatient hip and knee replacements, so we know a thing or two about what it takes to launch a successful program. We also know that by upgrading your ortho offerings now, you'll be ideally positioned to meet a growing patient demand and out in front of the cutting edge of care, waiting for other facilities to catch up. If your orthopedic center is already performing major joint repairs, adding outpatient total joints is well within your reach. Here's what you need to know to make it happen.

Planning and prepping
To ultimately succeed at outpatient total joints, you need surgeons who are committed to the idea — who are willing to start the program, who are going to build and improve on it, and who are ultimately going to champion it. Once you have that, it becomes possible to line up the buy-in and commitment you need from the rest of the team.

With the right care plan in place, most patients can ambulate within a few hours of surgery, and most want to get home as soon as possible. My patient selection criteria for inpatient and outpatient are very similar. Truly sick patients — those with major cardiac issues or seizure disorders, for example — aren't good outpatient candidates. One thing that will disqualify patients, at least temporarily, is obesity. We're not afraid to say: You're going to be a great candidate for outpatient surgery, but first, we'd like you to get your BMI down below 40. Most people will do that, given a rationale. They want the surgery to be easier and they want to decrease the chance of infection.

Although outpatient total joints aren't for every patient, there's a large segment of the population for whom it's the perfect choice. In fact, I recently did an outpatient total joint on an octogenarian. We tend to underestimate patients, even those in their 80s. And this new approach aligns perfectly with where health care — with its increasing emphasis on costs — is heading. Most total-joint patients don't need overnight stays. In fact, of the dozen or so patients I've talked to who've had one joint done in a hospital and another done in an ASC, without exception, they've preferred the ASC experience.

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