sions aren't always needed because the plastic on the implant wore
down, but because of periprosthetic fractures and joint infections.
• Not everyone's a candidate for same-day discharge. Now that
Medicare is on board with outpatient total knee arthroplasty (TKA)
reimbursement, it's important to remember that we shouldn't rush
every patient out the door in 4 hours. Yes, we're performing more and
more joint replacements in ambulatory surgical centers, but not every
patient is a candidate for same-day discharge. Keeping some patients
overnight is better for patient care.
For a subset of healthy Medicare patients with a complication rate
similar to an inpatient stay, next-day or 23-hour discharge may be the
"sweet spot" that minimizes complications, according to a study in
The Journal of Arthroplasty that I co-authored, "Can Total Knee
Arthroplasty Be Performed Safely as an Outpatient in the Medicare
Population?" (osmag.net/YbhQN6).
Our study compared the complication rates among outpatient
(same-day discharge), short-stay (discharge within 1 day) and inpa-
tient TKA in the hopes of identifying the ideal candidates for an outpa-
tient or short-stay procedure. We concluded that older patients with
more medical comorbidities should at least spend the night.
Our research could influence whether surgeons perform their knee
replacements in hospitals or ASCs, especially in states that cap the
length of stay at an ASC at 4 hours. Healthy patients who can go home
the same day can be done at lower-cost ASCs. Older patients and
those with more comorbidities should be done at full-service hospi-
tals.
It's a testament to our rapid recovery protocols, multimodal anesthe-
sia and accelerated physical therapy that we're debating whether to
keep TKA patients overnight when the average length of stay for joint
On Point
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