Outpatient-Focused Joint Arthroplasty Is the Future: The Midwest Center for Joint Replacement Experience

Berend, Michael E.; Lackey, Wesley G.; Carter, Joshua L.

doi:10.1016/j.arth.2018.02.002

Cited by 44 publications

(30 citation statements)

References 3 publications

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“…33 It comes as no surprise that patients undergoing same day discharge have reported excellent patient satisfaction when participating in a comprehensive OP total joint program that utilizes careful patient selection, refined surgical techniques, modern anesthesia protocols (including selective nerve blocks), and multimodal pain management regimens that limit the reliance on narcotic medications. 12,[34][35][36][37] The literature is largely in agreement supporting that OP TKA can be safely performed. Prospective studies are needed to better delineate the ideal candidate for OP TKA.…”

Section: Outcomes Of Outpatient Tkamentioning

confidence: 86%

Inpatient versus Outpatient Total Knee Arthroplasty

et al. 2019

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The rise of improved perioperative recovery protocols after total knee arthroplasty (TKA) has led to faster, more streamlined hospital stays for many patients. Combined with the implementation of value-based care and bundled payment initiatives, there has been a paradigm shift toward outpatient TKA surgery. This change to practice has been accelerated by recent policy changes enacted by the Center for Medicaid and Medicare Services regarding the removal of TKA as an inpatient only procedure as well as some insurance companies denying preauthorization for inpatient stays after TKA. Our review aims to address the inclusion and exclusion criteria for outpatient TKA consideration, examine the outcomes for outpatient joint replacement surgery, and discuss limitations of widespread adoption for same-day discharges.

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Section: Outcomes Of Outpatient Tkamentioning

confidence: 86%

Inpatient versus Outpatient Total Knee Arthroplasty

et al. 2019

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“…It should also be noted that the NIS contains information on surgeries performed at centers with inpatient capacity. Therefore, our results could underestimate the true procedural backlog as primary THA and TKA are increasingly being performed at ambulatory centers, although this is a minority of patients on a national scale [ 8 , 9 , 23 ]. Finally, despite these weaknesses, the use of population-level data is a strength of this study.…”

Section: Discussionmentioning

confidence: 99%

Quantifying the Backlog of Total Hip and Knee Arthroplasty Cases: Predicting the Impact of COVID-19

Wilson

Schwartz

Farley

et al. 2020

HSS Journal®: The Musculoskeletal Journal of Hospital for Speci

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Background Total hip arthroplasty (THA) and total knee arthroplasty (TKA) are two high-volume procedures that were delayed due to COVID-19. Questions/Purposes To help strategize an effective return to elective orthopedic surgery, we aimed to quantify the volume of THA and TKA cases delayed across the USA and estimate the time required to care for these patients when non-urgent surgery resumes. Methods Population-level data was used to estimate monthly THA and TKA procedural volume from 2011 to 2017. Using linear regression, we used this data to project monthly procedural volumes for 2020 to 2023. Nine different permutations were modeled to account for variations in case delay rates (50%, 75%, 100%) and in resumption of non-urgent procedure timing. Two recovery pathways using the highest volume month as a surrogate for maximum operative capacity, and a second using the highest month + 20% were used to simulate a theoretical expansion of current capacity. Results The projected national volume of delayed cases was 155,293 (mid-March through April; 95% CI 142,004 to 168,580), 260,806 (through May; 95% CI 238,658 to 282,952), and 372,706 (through June; 95% CI 341,699 to 403,709). The best- and worst-case scenarios for delayed cases were 77,646 (95% CI 71,002 to 84,290) and 372,706 (95% CI 341,699 to 403,709), respectively. The projected catch-up time varied between 9 and nearly 35 months for the best- and worst-case scenarios. The addition of 20% increased productivity decreased this time to between 3.21 and 11.59 months. Conclusion The COVID-19 pandemic has generated a significant backlog of THA and TKA procedures. Surgeons, administrators, and policymakers should account for these modeled estimates of case volume delays and projected demands. Electronic supplementary material The online version of this article (10.1007/s11420-020-09806-z) contains supplementary material, which is available to authorized users.

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“…The safety of major surgery in ambulatory surgery centers has been questioned in mainstream media [20] . Limited studies have been published examining the safety of outpatient TJA in the ASC setting immediately after initiating a program [2] . The purpose of this study was to demonstrate the safety of outpatient TJA in a freestanding ASC immediately after establishing an evidence-based TJA outpatient program.…”

Section: Discussionmentioning

confidence: 99%

“…There has been a trend toward short hospitalizations, which has been facilitated by refinements in surgical techniques, advancements in pharmacologic regimens, and modification of postoperative physical therapy pathways. The development of such clinical efficiencies, such as comprehensive pre and perioperative pathways, has allowed for the development of truly outpatient or ambulatory total joint surgery [2] , [3] , [4] , [5] , [6] . Today, there is an increasing interest in outpatient TJA as there are perceived advantages for the patient, potential cost reduction [7] , and general benefits to the health-care system.…”

Section: Introductionmentioning

confidence: 99%

“…Furthermore, the definition of outpatient TJA in some studies has included overnight stay of under 23 hours [16] . Although there are potential benefits associated with TJA at an ambulatory surgical center (ASC), potential complications and safety of outpatient TJA at a standalone ASC continue to be quantified and demonstrate promising outcomes with complication rates ≤7% [2] , [17] , [18] , [19] . However, safety of major surgeries at ASCs continues to be questioned in mainstream media [20] .…”

Section: Introductionmentioning

confidence: 99%

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Is it safe? Outpatient total joint arthroplasty with discharge to home at a freestanding ambulatory surgical center

et al. 2018

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BackgroundTotal joint arthroplasty (TJA) is trending toward shorter hospitalizations; as a result, there are many ambulatory surgical centers (ASCs) starting to perform outpatient TJA. However, there are limited studies examining the safety of outpatient TJA in the freestanding ASC setting. This study aims to evaluate 30-day and 90-day complication rates in patients who underwent outpatient TJA at a freestanding, independent ASC with direct discharge to home.MethodsA retrospective cohort review using health records was performed on the first 115 TJAs performed between August 2015 and March 2017 by one of the 4 orthopedic surgeons. Before the first TJA, the ASC had developed a multidisciplinary TJA pathway.ResultsOf the 115 TJAs, 37 (32%) were total hip arthroplasties (THAs), 53 (46%) total knee arthroplasties (TKAs), and 25 (22%) unicompartmental knee arthroplasties, with a mean age of 57 ± 7 years and body mass index of 30 ± 5 kg/m2. There were no intraoperative or direct ASC-related complications. There was 1 instance (0.9%) of a postoperative minimally displaced intertrochanteric femur fracture after THA due to a fall treated nonoperatively complication within 30 days of surgery. Of the 90-day complication events, there were 2 patients (2%) with postoperative arthrofibrosis of the knee after TKA requiring manipulation under anesthesia, 1 postoperative patellar tendon rupture during therapy after TKA requiring surgical repair and 1 delayed hematogenous infection after international travel after THA requiring 2-staged exchange.ConclusionsOutpatient TJA with discharge to home at a freestanding, independent ASC is a safe option after development of a multidisciplinary TJA pathway.

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Outpatient-Focused Joint Arthroplasty Is the Future: The Midwest Center for Joint Replacement Experience

Cited by 44 publications

References 3 publications

Inpatient versus Outpatient Total Knee Arthroplasty

Inpatient versus Outpatient Total Knee Arthroplasty

Quantifying the Backlog of Total Hip and Knee Arthroplasty Cases: Predicting the Impact of COVID-19

Is it safe? Outpatient total joint arthroplasty with discharge to home at a freestanding ambulatory surgical center

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