implant. If you open up an instrument tray and it's contaminated,
will you have another one available? What if you drop an implant?
• Cost containment. In this era of bundled payments that
cover an entire episode of care, make sure you're using
implants that won't eat up a substantial amount of the reim-
bursement. If a patient requires a complicated hip replace-
ment that requires additional equipment, consider moving that
procedure to the local hospital.
Also pay attention to comorbidities that can contribute to nega-
tive outcomes. If you don't, the patient might end up being trans-
ferred to the hospital, which will incur costs from the emergency
room and the hospital if admission is necessary. The financial
benefits of outpatient surgery are negated by a patient being
transferred to the hospital or visiting the emergency department
after discharge from the outpatient setting.
• Proven results. A high transfusion rate or a relatively high
complication rate may indicate that a surgeon is not ready to do
total hip replacement as an outpatient procedure. I discourage
surgeons from attempting an outpatient total joint until they can
simulate successful same-day discharge from the hospital.
— Patrick Toy, MD
2 0 • O U T PA T I E N T S U R G E R Y M A G A Z I N E • A U G U S T 2 0 1 8
can start to walk. Once patients regain motor and sensory function,
a trained physical therapist mobilizes them, with the goal of walking
100 feet. Additional discharge criteria are pain control with oral
medications, tolerating a normal diet without nausea, mobilization
without orthostatic hypotension, stable vital signs/asymptomatic
acute blood loss anemia and a successful episode of controlled void-
ing.
• At-home recovery is best. Rather than being discharged to
