Dr. Ravi Bashyal: Key trends in outpatient knee, hip surgery

Ravi Bashyal, MD, is an orthopedic surgeon and Director of Outpatient Hip and Knee Replacement Surgery at NorthShore University HealthSystem in Skokie, Ill.

Here, he discusses the big concepts and ideas around outpatient joint replacements.

Q: What are the biggest technology trends you are seeing in outpatient knee and hip surgery?

Dr. Ravi Bashyal: The use of innovative technology to help enable successful outpatient total joint replacement continues to expand. One game changing technology in this space is patient-specific instrumentation for total and partial knee replacement. This technology emphasizes customization and pre-operative planning to allow for more accurate and efficient surgery. It can also reduce the number of trays and implant inventory needed for surgery which has a direct impact on lowering cost.

Another trending technology is the use of portable negative pressure wound therapy dressings. These unique dressings can help to manage post-surgical drainage and edema, and may improve perfusion and incision healing, all while providing an occlusive barrier to the outside environment. This type of management has been shown to decrease wound complications, decrease readmission, and improve early outcomes, all of which are critically important in the outpatient space.

Q: Half of your outpatient procedures return home without any narcotics. To what do you attribute your success?

RB: The biggest part of our success with sending patients home, and with minimal or no use of narcotics, is effective communication and standardization. The patient, their family, and our team's mentality is that they will have minimal pain from start to finish. We begin the messaging on their first office visit and this is continuously reinforced throughout the outpatient process and even after they are at home.

Q: What challenges are there for taking total joint replacements outpatient? How are you overcoming them?

RB: The biggest challenge is managing all the touch points, which means managing all the interactions with the patients and their families. The messaging to the patient has to be consistent, from the initial office visit with me and my team, to the anesthesia encounter immediately before surgery, to the post-op discharge instructions from the recovery room RNs – and all the interactions with staff in between these. It can be challenge to have all the stakeholders in this process on the same page. It takes effort and persistence to accomplish this – but once done, allows for a seamless concierge level experience for patients and their families.

Q: What are you doing today to prepare for the future?

RB: We are trying to embrace innovative technology where appropriate. We accept that hip and knee replacement surgery has been a historically successful procedure in the inpatient setting. That being said, improvements including the technologies and messaging strategies discussed above are allowing us to safely transition many cases to the outpatient setting. We continue to evaluate and adopt innovative technologies to help accomplish these goals.

Ultimately, we must sustain and maintain the safety and high-quality outcomes of these procedures while maximizing efficiency and productivity. We are also preparing for a larger population of outpatient total joints and learning how to better identify those that are appropriate for the outpatient setting will be key as this space continues to expand and grow.

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