Current Concepts in Joint Replacement Winter Meeting

Current Concepts in Joint Replacement Winter Meeting

Source:

Della Valle CJ. Outpatient surgery for TKA and THA. Here to stay: Figure out how to do it. Presented at: Current Concepts in Joint Replacement Winter Meeting; Dec. 8-12, 2020 (virtual meeting).

Disclosures: Della Valle reports he owns shares in Munster Specialty Surgery Center and North Shore Surgical Suites; receives royalties from Zimmer Biomet and Smith & Nephew; receives research support from Zimmer Biomet, Smith & Nephew and Stryker; and is a paid consultant for DePuy Synthes.
December 11, 2020
2 min read
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Outpatient TJA improves patient satisfaction and may favor the surgeon

Source:

Della Valle CJ. Outpatient surgery for TKA and THA. Here to stay: Figure out how to do it. Presented at: Current Concepts in Joint Replacement Winter Meeting; Dec. 8-12, 2020 (virtual meeting).

Disclosures: Della Valle reports he owns shares in Munster Specialty Surgery Center and North Shore Surgical Suites; receives royalties from Zimmer Biomet and Smith & Nephew; receives research support from Zimmer Biomet, Smith & Nephew and Stryker; and is a paid consultant for DePuy Synthes.
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Outpatient total joint arthroplasty provides a safe option for the right candidate, increases patient satisfaction and may be beneficial for the surgeon, according to a presenter at the Current Concepts in Joint Replacement Winter Meeting.

Outpatient surgery can increase surgeon demand. “The bottom line is: [Outpatient surgery] is going to cause more work for you and your practice, not less work,” Craig J. Della Valle, MD, professor of orthopedic surgery and chief of the section of adult reconstruction at Rush University Medical Center, said while presenting his case for outpatient TJA during a debate session.

Outpatient surgery is not a 1-day ordeal for the surgeon. It requires careful and frequent follow-up, and patients should have access to the surgeon or physician extender at all times, Della Valle said. It also requires a confident surgeon who is capable of delivering a consistent product, he added.

‘Here to stay’

Craig J. Della Valle
Craig J. Della Valle

Medicare, the nation’s largest insurer of TJA procedures, currently covers TKA performed in an ASC and “will probably start covering” THA in an ASC in 2021, Della Valle said.

“In addition, the private insurers are going to start incentivizing you to perform [TJA] in an ASC with an increase in reimbursement in your professional fees,” he added. “Likewise, they are going to reduce your professional fees if you perform a case in an inpatient setting that they feel is appropriate for an outpatient setting.”

Equivalent safety, increased satisfaction

According to Della Valle, the most recent literature shows no difference in readmissions, complications and ED or clinic visits between patients who received TJA in an outpatient or inpatient setting; however, patient selection is important.

“In terms of making [outpatient TJA] safe, patient selection is a critical part of the formula. You want to be looking at doing these types of procedures - as an outpatient - on patients who are relatively healthy with minimal comorbidities,” he said. “You also want to make sure that these are patients that you can trust – patients who are going to call you if they have an issue, patients who have a good support network. Because if not, you are going to be looking at a high rate of readmissions and ER visits.”

Lastly, patient satisfaction is shown to be higher in patients operated on in the ASC compared with patients who had traditional inpatient stays, Della Valle said. Overall experience, explanation of medications, pain management, preparedness for discharge and courtesy from nurses all favored patients in the outpatient setting, he added.

“When you follow those principles, I think the data suggests that this can be done safely and with just as good – if not better – satisfaction than done in the hospital setting,” Della Valle said.