Deal-breakers
Understanding who is not a suitable candidate for having pro-
cedures done in the outpatient setting will help you focus on those
who are, says Gwo-Chin Lee, MD, an associate professor of orthope-
dic surgery at the Presbyterian Medical Center of Philadelphia and
fellowship director of adult reconstruction at the University of
Pennsylvania.
Dr. Lee conducted a recent study that looked at complication rates
following total joint procedures. He found that about 7% of patients
undergoing a total knee or total hip replacement — including both
short-stay patients and inpatients — suffered from complications that
required visits to the ER or a doctor's office. Most of the patients who
developed serious complications had cardiopulmonary problems
(osmag.net/QKVg2x).
From his study results, he came up with 5 conditions that should
disqualify a patient for same-day joint replacement:
• congestive heart failure
• cirrhosis of the liver
• coronary heart disease
• coronary artery disease
• chronic COPD
Dr. Caillouette begins the patient selection process by considering
patients' ASA scores. "I don't take patients as outpatients if they don't
have a 1 or 2 ASA score," he says. "Any history of cardiopulmonary
problems is also a deal-breaker."
It's also crucial to make sure patients want to go home the same day
of surgery. "Some patients come in with the expectation that they're
going to stay in the hospital for a number of days," says Dr. Lee. "Those
patients are obviously not good candidates. A patient's attitude has very
little to do with the medical side of patient selection, but it's an impor-
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