One hospital’s experience with the 3-hour Outpatient Unicompartmental Knee Replacement
NEW DATA ON 3-HOUR OUTPATIENT PARTIAL KNEE REPLACEMENT (Orthopedics This Week)
Don’t fear the outpatient experience, says the largest study ever on outpatient partial knee replacement. Robert S. Gorab, M.D. is the chief medical officer at the Hoag Orthopedic Institute (HOI) in Irvine, California. He tells OTW, “Our study, just published in The Journal of Arthroplasty, found that after unicompartmental knee arthroplasty (UKA), day of surgery discharge for appropriate patients can be both safe, efficient and even increase patient satisfaction. We took 160 consecutive patients with appropriate risk profiles and performed all the procedures on an outpatient basis.
We found that there were no readmissions, no re-evaluations for nausea, no falls, and no acute post-surgical complications. We had a broad age range—people in their 40s all the way up to 83 years of age. And the average length of stay was less than three hours! The success of these procedures can largely be attributed to the strong educational process that we have at our facility.
There are both nurse practitioners and physician assistants that work through the educational process with the patient; they review safety issues and provide education for the family. In all, they spend approximately an hour and a half with each patient the week before surgery in order to optimize the entire process. Some patients also receive pre-surgical physical therapy, such as gait training with ambulatory aids.
I believe that in order to successfully perform these partial knee replacement surgeries on an outpatient basis you need a facility with solid orthopedic infrastructure that performs a reasonable volume to handle these larger procedures. The administrative team, in cooperation with the physician leaders, must spend time standardizing surgical protocols and recovery pathways to optimize results. We also have a physical therapy department in our office that sees the patients after surgery and before they go home to ensure they are safely discharged.”