Caution still required as TJR with same-day discharge rises in prevalence

Although same-day outpatient hip and knee procedures are becoming more common in orthopedics and early studies have highlighted good results and low complication rates, physicians who spoke with Orthopedics Today noted patient selection, properly outfitted facilities and staff and patient readiness are keys to optimal outcomes.

“Patients are happier going home [and] recovering in their familiar environment. We have seen a lower complication rate with patients getting out of the hospital sooner,” Richard A. Berger, MD, assistant professor of orthopedics, told Orthopedics Today. “A hospital is a great place to be when you are sick, but it is not a great place to be if you are healthy and just recovering from a simple operation.”

Physicians who spoke with Orthopedics Today noted that patient selection is key in determining the appropriateness of same-day outpatient total joint replacement (TJR), and that ideal candidates are typically younger and with few comorbidities.

“Obviously, if you are going to undertake this you want the patients selected to be your healthier patients, the patients with the least medical comorbidities, and I think these have to be patients who have the appropriate expectations,” Michael P. Bolognesi, MD, director of the Total Joint Fellowship, said. “These patients need to be educated up front about the likelihood of leaving the same day, and they should have a certain level of motivation because obviously not every patient has that expectation or desire.”


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