Page 39 - 2020 Annual Outcomes Report
P. 39

 Recovering Faster and Safely at Home Following Total Joint Replacement Surgery
 by Nader Nassif, MD
Over the past decade, the length of stay of joint replacement surgery has gradually decreased. With patient optimization and
standardized pathways, many patients can be safely discharged on the day of surgery. This has recently been accelerated by the Center for Medicare Services (CMS) move to allow total knee replacements to be performed as an outpatient in 2019 and total hip replacements in 2020.
Hoag Orthopedic Institute (HOI) has been at the forefront of enhanced recovery protocols that allow for same-day discharge following hip or knee replacement. In a multidisciplinary effort involving orthopedic surgeons, anesthesiologists, internists, nursing and administration, HOI has thoughtfully developed protocols to maximize patient outcomes and safety while minimizing hospital stay. The patients who go through HOI’s enhanced recovery protocol spend an average of six hours in the hospital after surgery.
The key to the program’s success is ensuring appropriate criteria for same-day discharge, which includes patients with no active medical issues and who have at-home social support for assistance after surgery. Those who do not meet these criteria follow the standard pathway and spend one night in the hospital.
Since 2015, HOI has improved its preoperative and postoperative protocols to facilitate an enhanced patient experience and decrease pain and complications post-surgery. The protocols include improved preoperative hydration to reduce nausea, improved pain protocols, and elimination of catheters and drains. In addition, at-home physical therapy is initiated the day after discharge, and
patients see their surgeons at regular intervals to ensure they are progressing appropriately.
Nearly 2,000 HOI patients have experienced this rigorous program, with approximately 85% meeting the criteria for same-day discharge. Patients did well after going home, and less than 1% were readmitted for complications. This rate is similar to or better than HOI’s traditional pathway and historical data from other institutions.
The transition to outpatient joint replacement surgery has been especially relevant with the COVID-19 pandemic. As elective surgeries resumed after the six-week statewide shutdown, patients, families and surgeons agreed that recovery at home rather than in the hospital was safer. With HOI’s foundation and knowledge of enhanced recovery and same-day discharge, HOI surgeons have successfully transitioned more patients to a rapid recovery pathway with the same excellent outcomes.
  Meet one of our patients, Ned, who went through the Enhanced Recovery Program and was back walking within 48 hours without pain.
Read more about his story: hoagorthopedicinstitute. com/patient-stories/back-to-walking2/
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