both given orally. We stopped giving intrathecal narcotics such as
morphine, as they can lead to nausea and urinary retention — condi-
tions that often delay discharge.
Of course, there's always a risk of nausea following major surgery,
so we've started giving dexamethasone to patients pre-operatively.
We'll administer a 10 mg injection of the corticosteroid just before sur-
gery and the home health nurse will administer another 10 mg injec-
tion the next morning. A 2011 article that examined the effects of dex-
amethasone on post-op nausea and vomiting found that it prevented
early and late vomiting in adults in every 1 out of 7.1 cases and that
dexamethasone was equal to or better than other antiemetic drugs in
preventing PONV.
Outpatient total hips?
At first we were skeptical about the concept of hip replacement with-
out a hospital stay. Discharging a patient in 3 hours who just under-
went a bloody and painful surgery that usually requires 2, 3 or more
days in a hospital is pretty ambitious. But like most things, we've
found our success by focusing on the fundamentals: patient educa-
tion, a structured surgical day, physical therapy and home nursing
care.
OSM
F E B R U A R U Y 2 0 1 8 • O U T PA T I E N TS U R G E R Y. N E T • 8 9
Discharging a patient in 3 hours? Yes, at first we were skeptical
about the concept of hip replacement without a hospital stay.
Dr. McClellan (cmcclellan@uoc.com) specializes in total joint replacement. He
is a partner in University Orthopedics Center in Altoona, Pa.
