Daxton Steele, MD, a hip and knee replacement specialist at Gulf Breeze, Fla.-based Andrews Institute for Orthopaedics & Sports Medicine, discussed the changing landscape around joint replacement procedures.
In an interview for Andrews Institute, he talked about how the orthopedic industry reached this point concerning joint replacements and reviewed the benefits to both patients and payers.
Note: Transcript was edited for style.
Dr. G. Daxton Steele: Traditionally, total hip and knee replacements have been done as an inpatient procedure — where a patient would stay in the hospital for as long as a week when we first started. We've cut that down from five days ... to the point where we can do a joint replacement as an outpatient procedure where the patient goes home the same day. Most of the changes we made were mainly with anesthesia and pain control. We're able to control patients' pain a lot better and get a lot of the work done ahead of surgery — and that's helped a lot to allow patients to do this as an outpatient procedure.
Initially, we used to leave patients in bed for quite a while after the procedure, and we've learned that it was not helpful for the patients — it wasn't good for their heart, their lungs or the joint itself. We've learned to get the patient mobile immediately. Now, obviously we can do joint replacements as an inpatient procedure in the hospital, but it tends to be a little more natural when the patient goes home after the joint replacement because they're forced to get up and move around more within their own home. So that in and of itself [accelerates] the rehab process for these outpatient patients.
We're still in the learning phase of determining who the best candidates are for outpatient are and who still requires inpatient for a total joint. Obviously, we know there are patients that require hospital monitoring for an extended period of time after a surgery — and we obviously know there are some patients who have no medical problems and are good candidates for outpatient total joint procedures. The question is identifying what's best for those patients that fall somewhere in between.
Most of the benefits of an outpatient total joint procedure are based on convenience for the patient. Patients don't want to be in the hospital and want to go home in the comfort of their own home. Pain control is easier when you're in your own home, we've learned. Then some patients prefer the comfort of inpatient hospital. We don't force anyone to do outpatient versus inpatient.
There is also the insurance component. Obviously insurance companies are driving [the outpatient migration because] they would rather patients do outpatient surgery, if they can, because it costs them less money and it's more efficient for the entire system.
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