8
O R E X C E L L E N C E. C O M 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 | J U N E 2 0 1 4
very invasive, pain control was primitive and the patient was immobile for
days, admitting these patients was necessary. But a lot has changed since
then. Modern surgeons who use minimally invasive approaches for knee
and hip surgery can do a knee in less than 40 minutes and patients lose
less than 100cc of blood. Meanwhile, continuous nerve blocks provide out-
standing pain control. We don't need opioids, so side effects like PONV,
ileus, respiratory depression or pruritis are non-issues. Plus, home recov-
ery patients avoid all the risks of a hospital stay, like medication errors and
nosocomial infections. Patients are also more comfortable, they sleep bet-
ter, and they rehab better.
• The results so far. A look back at our first 100 patients indicates that
this approach produces better results than the inpatient approach. Thanks
to the terrific pain control provided by our anesthesia team, these patients
never experience breakthrough pain and never have to visit the ER. Our
DVT incidence is very low — 1 incident in 100 cases — probably because
our patients are so active post-op and our PT is so aggressive. We've had 1
fall, requiring re-suture of the wound. And we've had 1 superficial infec-
tion, which cleared with a little antibiotic coverage. We've had zero read-
missions.
• The most difficult aspect of doing same-day total joints. At
this point in our program, the biggest challenge is physically getting the
patient back in his house. Patients feel so good after the procedure we've
actually heard some stop at Dairy Queen on the way home. Once they get
to the house, though, if there's a significant number of steps, we have to
deal with it. We have the home nurse and the PT specialist meet the
patient in the driveway to help get him in the house, assessed and tucked
in.
K I C K E R
1406_ORX_guide_Layout 1 5/29/14 3:22 PM Page 8
