How outpatient orthopedic surgery has evolved and what's next

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Outpatient surgery has become a hot topic in orthopedics.

Brett Shore, MD, an orthopedic surgeon at DISC Sports & Spine Center in Marina del Rey, Calif., connected with Becker's to answer "What's next for outpatient orthopedic surgery?"

Note: This response has been lightly edited for length and clarity.

Dr. Brett Shore: Outpatient orthopedic surgery has evolved dramatically in the last two decades. During my orthopedic training, patients undergoing total joint replacements stayed in the hospital for a minimum of two to three days, patients undergoing spinal fusion two to five days (or more), and even ACL reconstructions and rotator cuff repairs sometimes remained in the hospital overnight. Thanks to advancements in perioperative pain management and improved surgical techniques, along with recognition of the financial benefit of surgeries being performed in the outpatient setting, more surgeries are being shifted to the ASC setting than anybody thought possible 20 years ago, with better outcomes for all involved parties. 

One of the next areas of innovation in this space will likely revolve around patient optimization. We optimize patients by treating pre-existing medical conditions, managing lab abnormalities, and prehabilitation of their physical condition, all of which improve outcomes and reduce complications.

Nutritional optimization, however, is an under-appreciated part in preparing a patient for surgery, and an area where we can make dramatic improvements that will further reduce complications and improve outcomes for our patients. Amino acid and protein supplementation can reduce preoperative muscle loss, and carbohydrate loading will help patients recover more quickly from the physiologic hit of anesthesia and surgery. While these areas are currently under investigation, more research is needed in the area of nutritional optimization to understand exactly how to best prepare patients for surgery, allowing movement of even more patients and surgical procedures to the outpatient setting.

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