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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 | M O N T H 2 0 1 4
other comorbidities and home environments.
Age is not a limiting factor, but health certainly is. Candidates must be
relatively healthy with no serious comorbidities such as active cardiac and
pulmonary issues. As a rule, patients who are extremely obese or on sleep
apnea machines aren't suitable candidates for same-day discharge. But
most patients without active medical problems have the opportunity to go
home if they prefer.
Anesthesia definitely needs to work closely with surgeons who want to
perform outpatient knee replacements, and needs to use a light touch so
patients are able to ambulate soon after reaching the recovery unit.
I do all of my cases with short-acting spinal anesthesia. My initial attempts
involved spinals that didn't wear off for
4 to 5 hours after surgery, meaning
patients were having difficulty complet-
ing the physical and occupational thera-
pies needed to meet same-day discharge
criteria.
Now, providers administer a small vol-
ume of a low-dose anesthetic so the
block wears off in a couple hours.
Patients are able to walk 50 to 100 feet
soon after surgery, a necessary step
before discharge.
Ambulating as soon as possible after
surgery is also the best way to prevent
DVT, perhaps the most dangerous and
common post-op complication of joint
replacement procedures.
Sequential compression devices are
excellent for preventing DVT in hospi-
O R T H O P E D I C S
KNEE DEEP Causing minimal damage and prop-
erly placing implant components are keys to suc-
cess.
Jeffrey
G.
Mokris,
MD
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