Abstract
Yes the paradigm is changing!!!
Refinement of surgical techniques, anesthesia protocols, and patient selection has facilitated this transformation to same day discharge for arthroplasty care. The trend for early discharge has already happened for procedures formerly regarded as “inpatient” procedures such as upper extremity surgery, arthroscopy, ACL reconstruction, foot and ankle procedures, and rotator cuff repair. Our program began focused on Partial Knee Arthroplasty (PKA) and has now expanded to primary TKA and THA, and select revision cases. Over the past few years we have performed: 138 TKA, 111 THA, 244 Partial KA, 6 RevTKA, and 6 RevTHA with no readmissions for pain control. With preoperative Hgb above 11 combined with Tranexamic Acid we have had no transfusions. Medical optimization is critical to the safety and success of patient selection for same day discharge. We utilise a standardised format for preadmission testing.
The program centers on the patient, their family, home recovery, preoperative education, efficient surgery, and represents a shift in the paradigm of arthroplasty care. It can be highly beneficial to patients, surgeons, anesthesia, facility costs, and payors as arthroplasty procedures shift to the outpatient space.
