Alexander P. Sah
DALLAS — Perhaps more than anything else, successful outpatient total joint arthroplasty has to do with extra education and the size of the window of time after the procedure is performed but before discharge, according to a presenter at the American Association of Hip and Knee Surgeons Annual Meeting, here.
The surgeon, office and OR staff must be aware that the patient’s overall operative and postoperative experience at an ASC is similar to and just as important as if the procedure was being performed in a hospital, Alexander P. Sah, MD, said.
“Really a lot of the work occurs in the beginning — so, patient selection, preoperative education [and] discharge planning. All of this discharge planning occurs even before we get that patient to the operating room,” Sah said. “We have to anticipate, because preparation in the beginning can prevent these delayed discharges and readmissions in the end.”
The main consideration for patients who undergo TJA at an ASC is that they are exposed to earlier variability in their symptoms, which may occur in the 6- to 24-hour window after surgery, according to Sah.
For example, “Many times, this may be their first occurrence [of nausea, when they go home],” he said.
As patients do not know what to do in that situation, the risk for readmission or call backs with concerns or questions is greater, he noted, saying this is a situation for which surgeons and the ASC and office staff must be prepared.
Additionally, patients scheduled to undergo TJA in the ASC setting need more preoperative education than patients who are exposed to standard TJA protocols, Sah noted.
“We need to set expectations throughout the first consultation and we should probably be preparing to figure out who is that caretaker, who is that support system on that same visit,” he said. “We have to provide more information in a shorter amount of time because, remember, we are exposing our patients to this earlier 6- to 24-hour window. So, we need to teach them how to manage early pain, early nausea, early swelling — things we used to address under supervision. In that way, we can help avoid the panic and avoid [emergency room] ER visits and readmissions.”
The surgeon and staff must implement ways to help patients bridge the gap between discharge from the ASC and the first follow-up appointment, such as good coordination and communication practices, and providing patients with easy access to a live person when they need it via telephone, email or the internet, Sah said. – by Susan M. Rapp
Sah AH. Symposium 7: Office and staff protocols. Presented at: American Association of Hip and Knee Surgeons Annual Meeting; Nov. 1-4, 2018; Dallas.
Disclosure: Sah reports he is a paid presenter or speaker for Angiotech, Convatec, Mallinckrodt, Medtronic and Pacira; receives IP royalties from NextStep; receives research support from Zimmer Biomet; and has shares in an ASC.