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M O N T H 2 0 1 4 | S U P P L E M E N T T O O U T P AT 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
Plenty of planning
Over the last 3 years, we've done more than 800 outpatient total joints, 65% of
which were total knee arthroplasties. We reviewed the first 140 cases, and pre-
sented the findings at the American Academy of Orthopaedic Surgeons 2 years
ago. Our readmission and complication rates were in line with patients who
stayed 3 or 4 days in the hospital. In fact, the outpatients fared a little better.
Before that proven success, I met with the hospital's administration and our
clinical leaders — representatives from anesthesia, the OR, physical therapy,
occupational therapy and nursing —
several times to ensure it was feasible
and safe to perform total joints on an
outpatient basis. When everyone was on
board, we set up a standardized proto-
col that includes identifying candidates
for the procedure.
Not everyone meets the criteria
for outpatient joint replacement,
and clearing someone for surgery is
based on individual pre-op assess-
ments. We base the decision on
patients' current health, ASA scores,
O R T H O P E D I C S
I
've been doing total joint replacements for 25 years, and most of my
patients over the last decade have been able to go home the day after
surgery. About 3 years ago, all that changed when the head nurse on the
inpatient floor sparked an idea. "You know," she said, "your patients are
up and walking the night of surgery. Have you ever thought about let-
ting them go home the same day?" Now, about 60% of my patients are ready
and willing to go home hours after surgery, which I believe will become
commonplace in the next 5 years.
PRIME POSITION Table attachments help
place the knee at the proper flexion.
Jeffrey
G.
Mokris,
MD
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