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O R T H O P E D I C S
Richard Berger, MD
nt
enough for surgery, so we don't deny many patients the care they
seek. In fact, I recently operated on a 93-year-old man who went home
the same day.
We typically perform 8
knee arthroplasties in a day.
Patients who undergo surgery at 7 a.m. are usually
ready for discharge between
noon and 1 p.m. Those operated on in the early afternoon head home between 5
p.m. and 6 p.m. My hospital mandates that patients must get in and
out of bed without nurse assistance, and walk up and down a hallway
and stairs by themselves before being released. (Patients complete
brief post-op consultations with a physical therapist before being
cleared for discharge.) Most patients go home without need of a cane;
we give some crutches or, rarely, a walker.
It's critically important to set the expectations of patients and their
escorts for same-day discharge. My minimally invasive replacement
technique is really a minor procedure, so there's no reason most
patients shouldn't be able to go home a few hours after surgery.
They and their loved ones need to realize and expect that. They'll be
up and walking in PACU. They'll be comfortable and medically stable. They'll be ready to go home after a short stay in recovery. But if
unforeseen medical issues arise during the recovery phase or they
can't move around by themselves — rare occurrences in my experience — we'll keep them as long as needed, until they're ready for
appropriate and safe discharges.
Preemptive medication
is always better than
reactive medication —
you want to prevent
pain, not treat it.
J U N E 2013 | O U T PAT I E N T S U R G E R Y M A G A Z I N E O N L I N E
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