5 essentials for outpatient total joint success from University Hospitals' Dr. Matthew Kraay

Matthew Kraay, MD, an orthopedic surgeon at Cleveland-based University Hospitals, told Becker's ASC Review what he believes surgeons will need to succeed with outpatient total joint replacements in 2021.

Note: Response has been lightly edited for style.

Dr. Matthew Kraay: Until recently, outpatient joint replacement surgery has typically been limited to ASCs that specialize in these procedures. Removal of both total knee replacement and total hip arthroplasty from the Medicare [inpatient-only] list and state governmental mandates to limit elective surgery to procedures that do not require an overnight stay, in response to the COVID-19 pandemic, have stimulated additional movement of TKR and THA to the outpatient setting.

In many locales, the capacity of ASCs may not be sufficient to accommodate the growing demand for outpatient total joint replacement. These procedures can, however, be successfully performed in a hospital-based outpatient setting, if the patient is able to receive the high-intensity level of care they need on the day of surgery.

This will ideally require:

1. Motivated and engaged patients who are thoroughly evaluated and optimized medically, preoperatively.

2. A dedicated, highly collaborative team of caregivers who navigate the patients through the outpatient TJR surgery process and coordinate essential aspects of the patients' care perioperatively.

3. Effective anesthesia and pain management protocols that facilitate safe and rapid mobilization and recovery.

4. Comprehensive care paths that condense the critical elements of a short-stay inpatient episode of care into a same-day discharge pathway.

5. Hospital leadership support to provide appropriate therapy and nursing resources and a dedicated same-day discharge unit.


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