Research presented at the American Academy of Orthopaedic Surgeons' 2019 Annual Meeting March 12-16 in Las Vegas found Medicare-insured patients that follow an enhanced recovery after surgery protocol may be discharged early after outpatient total knee or hip arthroplasty.
The study included retrospective chart review data of 645 consecutive Medicare patients who underwent primary total knee arthroplasty (337 patients) or total hip arthroplasty (308 patients) between June 1, 2015 and November 16, 2017. The patients followed an opioid-sparing ERAS protocol including an intraoperative infiltration with Pacira Pharmaceuticals' Exparel, a non-opioid pain management drug. All surgeries were performed by James Van Horne, MD, of Grants Pass, Ore.-based Paragon Orthopedic Center, who also authored the study.
The key research details to know:
1. Following joint replacement, 84 percent of patients were discharged home the same day without home services.
2. The ERAS program included a non-opioid pain management regimen starting a week before surgery, spinal anesthesia, local infiltration and awake sedation with Exparel and bupivacaine HCl intraoperatively as well as a seven-day supply of opioids for patients to take as needed following surgery. Patients and caregivers were also educated prior to surgery about expectations, wound care and opioid use.
3. Beyond the initial seven-day prescription given at discharge, 84.2 percent of patients did not need any additional opioid prescriptions.
4. Dr. Van Horne said, "Our findings suggest that potential exists for Medicare-insured patients to undergo safe and successful [total knee arthroplasty] or [total hip arthroplasty] procedures as outpatient surgery with same-day discharge to home … this ERAS protocol, which was developed over the last 10 years to maximize the number of Medicare patients who could safely and reproducibly undergo outpatient joint replacement, suggests an important advance in our ability to offer these patients quality care that meets the ‘triple aim' of healthcare by improving the patient experience and population health while reducing healthcare costs."