Over the past 15 years, several studies have evaluated the safety and efficacy of outpatient total joint replacements, with the literature demonstrating minimal complications and improved outcomes for surgeries performed at ASCs.
Total joint replacements have been steadily migrating from hospitals toward outpatient settings for the past decade, with orthopedic leaders expecting the COVID-19 pandemic to accelerate this trend.
During a workshop sponsored by OrthAlign at Becker's Orthopedics + ASC Virtual Forum Aug. 26-27, Michael Ast, MD, orthopedic surgeon at New York City-based Hospital for Special Surgery, discussed the migration of total joint replacements to the outpatient setting, keys to providing reproducible outcomes in these surgeries and valuable technologies for ASCs to invest in.
Five key takeaways from the workshop:
1. Earlier discharges post-hip or -knee replacement is not something new. It's almost 20 years old, according to Dr. Ast, with most studies since then indicating positive outcomes for the patient. "The outcomes are not just positive on the clinical side, but there are certainly economic considerations and economic benefits for use of outpatient facilities to do joint replacement surgery."
2. The past five years have seen a significant rise in the number of ASCs incorporating total joint replacements into their practice. Dr. Ast attributes this growth to the development of specialized perioperative care protocols and efforts to minimize risks associated with shorter stays, among other factors.
3. Streamlining total joint procedures with improved navigation. Innovations in robotic and navigation systems have been booming in the orthopedic field, particularly for total joint replacements. The OrthAlign system, a single use handheld device with no capital expense, is "uniquely positioned for surgery centers," Dr. Ast said. Designed for partial and total hip and knee replacements, the system is an open platform that can be used with any implant system and has demonstrated its accuracy in more than 150,000 cases and 18 clinical studies.
4. Orthopedic surgeons should engage in more research on fluid management. Historically, the patients unable to be discharged on the day of surgery experienced nausea, vomiting and dizziness when they stood up to mobilize, Dr. Ast said. "Keeping patients at an appropriate level of fluid management can really avoid these complications." Ensuring patients are appropriately hydrated goes a long way toward enabling them to participate in their therapy after surgery.
5. Patient selection is key to achieving reproducible outcomes. Implementing strong protocols and methods for patient selection improves your ability to safely perform total joint replacements and provide predictable outcomes. "Not any one thing is perfect for every single patient," Dr. Ast said. "How I like to always think about this is you want the right patient in the right side of service at the right time."
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Click here, to view this workshop and more at Becker's Orthopedics + ASC Virtual Forum.