Outpatient joint replacement surgery benefits patients

ROCHESTER, Minn. — Outpatient surgery may be an option for people who are having their hips, knees or other joints replaced.

It is part of a trend in orthopedic surgery to move total joint arthroplasty, commonly known as joint replacement, from inpatient to outpatient surgery. Patients benefit from the shorter hospital stay, and they are more satisfied recovering at home.

A decade ago, a patient who had a knee or hip replacement would likely stay in the hospital for a week. Even four years ago, the average hospital stay was around four days. Some patients now can go home the same day, says Hugh M. Smith, M.D., Ph.D., a Mayo Clinic anesthesiologist.

“It is fundamentally a major surgery,” says Matthew Abdel, M.D., a Mayo Clinic orthopedic surgeon. “Everything related to that remains essential– preparing the patient, educating the patient, managing expectations, and having a multidisciplinary team in place – all must work together to allow that patient to go home that day safely.”

The hip, knee, and shoulder joints are most amenable to outpatient surgery, but not all joint replacement patients are candidates for outpatient surgery. Surgeons, anesthesiologists, advanced practice providers, nurses, pharmacists, physical and occupational therapists, and other care team members assess whether outpatient surgery is appropriate. They look at the patient’s medical condition, whether the patient will be safe and comfortable at home after surgery, have adequate pain control, and have a person who can care for them there, Dr. Smith says.

Before surgery, physical therapists work with patients, and utilize a robust strategy for making sure patients get enough fluids before surgery. During surgery, anesthesiologists use short-acting anesthetics, which help patients mobilize earlier after surgery.

Patients have been receptive to outpatient surgery, Dr. Abdel says. It mitigates risk factors such as infections acquired in the hospital, blood clots, and lung and urinary problems.

“It takes a village,” Dr. Smith says. “We’re talking about delivering very sophisticated, fairly innovative surgical and anesthetic techniques. Ultimately, it comes down to the people, a coordinated and integrated effort by a broad set of care providers, and systems that enable this type of outcome.”

“It’s a patient satisfier,” Dr. Abdel says. “You recuperate with your family. You recuperate in your home environment. You don’t feel like you’re institutionalized. You feel a part of a well model of care.”

For more information on outpatient joint replacement surgery, follow the link to the Q&A podcast on the Mayo Clinic News Network.

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