January 22, 2017
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Same-day discharge after TJA depends on several variables

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NEWPORT BEACH, Calif. — Patients discharged the same day after undergoing total joint arthroplasty have shown to be private pay patients with excellent comorbidity profiles and stable discharge environments, according to a speaker here.

“Why are we doing [same-day surgery]? The patients we are seeing are more young, more active and more motivated to recover at home. They do not see themselves as sick patients. They think of themselves as highly functioning patients who want to come in and improve their quality of life even further by having their pain in their hip or knee go away,” James Slover, MD, MS,  said at the Interdisciplinary Conference on Orthopedic Value-Based Care.

James Slover

In addition, surgeons want to have control over the process, which they can do better when the patients are at home.

“As we look at value-based care, the economics of these alternative payment methods are putting increased pressure on us for profitability of these joint replacement procedures. The transition for more outpatient procedures is going to be difficult, but it is driven by this. If we can do this more efficiently, maintain the quality and safety, then it is going to be a good thing for a value-based system,” Slover said.

He notes there have been projections that the number of outpatient total joint replacement procedures will increase by 200% in the next 5 years to 10 years, which translates to approximately 20% of all hip and knee replacement procedures that orthopedic surgeons do.

For same-day discharge, Slover advises orthopedic surgeons to go slow, pick good patients; educate those patients to ensure their infrastructure is in place; and ensure surgeons and all team members, including care management, physical therapists, occupational therapists, nurses, consulting medical staff, surgical coordinators/office staff and residents/fellows, are dedicated to the process. – by Nhu Te, MS

Reference:

Slover J. Can patients have a total hip or total knee and go home the same day? Presented at: Interdisciplinary Conference on Orthopedic Value-Based Care; Jan. 20-22, 2017; Newport Beach, Calif.

Disclosure: Slover reports he receives research support from National Institute of Arthritis and Musculoskeletal and Skin Diseases and institutional research support from Zimmer Biomet.