Outpatient total joint replacements

G. Daxton Steele, M.D.
Hip & Knee Replacement Specialist
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 Q: What has impacted surgeons to be able to do hip and knee replacements as outpatient procedures?
G. Daxton Steele, M.D.: Traditionally we've done a lot of total hip and total knee replacements as an inpatient procedure where a patient would stay in the hospital for as long as a week when we first started. We've been cutting that down to five days, to three days to an overnight stay till one day, and now we're at the point where we can do a surgery as an outpatient where the patient has the surgery and goes home the same day. Most of the changes we made are mainly due to anesthesia and pain control. We're able to control patients pain a lot better and get a lot of the work done ahead of surgery in terms of some of the equipment and materials that the patient might need and that's helped a lot to allow patients to do this as an outpatient procedure.
 Q: Talk about how total joint replacements have historically inpatient and what has impacted the ability for some of those to become outpatient.
G. Daxton Steele, M.D.: Initially, we used to leave patients in bed for quite a while after the procedure and we've learned that that was not helpful for the patients – that's not good for their heart their lungs and the joint itself. So as we've learned to get them up and get them more mobile immediately, that helps. Now, obviously we can do that as an inpatient in the hospital, but it tends to be a little more natural when they go home because they're forced to get up and move around a little more within their own home. So that in and of itself makes the rehab process accelerated for these outpatient patients.
 Q: What kinds of patients have a better chance of being outpatient?
G. Daxton Steele, M.D.: We're in the learning phase I'd say of determining who the best candidates for outpatient are and who still requires inpatient after a total joint. Obviously, we know there are some very sick patients that require hospital monitoring for an extended period of time 24 to 48, maybe even 72 hours after a surgery – and we obviously know there's some patients who have no medical problems have a very good home set up that are good candidates for outpatient total joint procedures. The question is, those patients that fall somewhere in between. We've got a lot of different parameters. We're measuring we're looking at the trying to figure out who are good candidates for inpatient – who are good candidates for outpatient. We're taking somewhat of a conservative approach right now trying to make sure we're not doing anybody in an accelerated fashion, but we're learning who those patients are and who does better with in patient versus outpatient at the current state.
 Q: What are the benefits of an outpatient total joint replacement?
G. Daxton Steele, M.D.: Most of the benefits from outpatient total joint procedures are a matter of convenience – patients that don't want to be in the hospital and want to go home in the comfort of their own home. They feel more comfortable there. Pain control is a little easier when your own home as we've learned. Some patients prefer the comfort of inpatient hospital and that's fine. We don't mind, we don't force anyone to do outpatient versus impatient. We just make the offerings currently and if it's more convenient and you enjoy it better than that's better for you. Also there's a the insurance component, obviously insurance companies are driving this a little bit in that they would they would rather patients do outpatient surgery if they can because it costs them a little less money and it's more efficient for the entire system.


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