Are You a Candidate for Outpatient Joint Surgery?
Over the past decade, the average hospital stay for total joint replacement patients has decreased from five days to typically less than two. Now, because of revolutionary advances in surgical techniques, anesthesia medications, pain management protocols, and customized physical therapy regimens, some patients are able to have outpatient joint surgery.
There are clear advantages to returning home on the same day as your surgery, including quicker recovery and significant cost savings, but it’s not appropriate for everyone. This article is intended to help you consider the advantages and disadvantages of same-day joint surgery, and also help you determine if you’re a candidate.
Where are Outpatient Joint Replacement Procedures Performed?
The majority of outpatient joint procedures are done in accredited ambulatory surgical centers (ASC). An ASC is a highly specialized health care facility that focuses on providing same-day surgical care with increased efficiency. Outpatient knee replacement and hip replacement procedures use the same technology and implants as traditional joint replacement surgery, but allow patients to recover in the comfort of their own homes. Surgeons are credentialed to operate in both hospital and ASC settings.
What are the Benefits of Outpatient Surgery?
- Reduced risk of infection: By choosing outpatient surgery, you avoid exposure to infectious diseases sometimes associated with hospital settings—something we’re all especially mindful of in these times. The estimated national average of surgical site infection rates at hospital facilities is around 2%, or 20 per 1,000 patients. Studies have shown that ASC infections rates are six times lower than hospital outpatient surgery departments. The infection rates at single specialty ASCs that perform only one type of surgery are even lower.
- Reduced out-of-pocket cost. ASCs offer high-quality, comprehensive total joint replacement surgery at a lower cost than hospital-based procedures. On average, patients pay less at an ASC compared to the identical total hip or total knee procedure performed in a hospital environment. Savings are typically reflected in co-pays and co-insurance. If you have a high insurance deductible or premium, you may save a substantial amount of money—as much as 40%—by avoiding the cost of overnight hospital care.
- Higher patient satisfaction: The narrower scope of procedures performed in the ASC setting allows for more specialized care and high patient satisfaction due to smaller and more personalized teams. According to Medicare.gov, the average hospital sees a three-out-of-five-star rating (approximately 60%). According to the Ambulatory Surgery Center Association, the average ASC sees a 92% satisfaction rate among patients.
- Surgery is performed in a safe, comfortable, predictable environment. Surgery centers are free-standing facilities that offer a pleasant, low-stress environment with convenient parking, strictly enforced quality control processes, and highly personalized care. Because ASCs can exercise better control over scheduling, surgical delays are limited. (In a hospital, your elective surgery can be “bumped” because of unanticipated emergency room needs.)
- Faster recovery. Surgeries at ASCs are often shorter and getting home quickly means you’re on an accelerated road to recovery. People who are comfortable at home heal faster and do better than those who are not in their own environment.
- Recover at home: You’ll be able to rest and heal in the comfort of you own home and sleep in your own bed, undisturbed by staff checks or other interruptions that are part of the hospital setting. You’ll also be able to eat your own food.
- You control your medications. You’ll be in charge of your pain medication regimen, rather than waiting for medications to be brought to you.
What are the Potential Disadvantages?
- Less medical supervision. When recovering at home, most patients do not have direct medical supervision, which could be a disadvantage in the first days after a joint replacement procedure. This is why only people who have a low risk of surgical complications are considered good candidates for outpatient surgeries.
- Recovering at home requires strong family support. Although patients are given extensive instructions for managing the recovery process at home, it is critical that they have someone there who can provide assistance.
- Concerns about pain management. The amount of pain and discomfort a patient experiences after surgery depends on multiple factors. We use evidence-based multimodal pain management techniques that facilitate a quicker recovery and return to mobility. Open communication with your OrthoEdge physician is an important part of helping us manage your pain.
Does Medicare Cover Outpatient Joint Replacement Surgery?
In 2018, the Centers for Medicare and Medicaid Services (CMS) approved payment for outpatient knee replacements. If your doctor believes you are a candidate for outpatient surgery, the cost of your knee surgery would be covered under Part B. In 2019, CMS removed total hip arthroplasty (THA), also known as hip replacement surgery, from the Inpatient-Only List, allowing THAs to be performed in a hospital-based outpatient department (HOPD).
Who is a Good Candidate for Outpatient Joint Replacement Surgery?
You’ve been told you need joint replacement surgery and you’re considering your options. If you meet certain important criteria, outlined below, then you could be a good candidate for same-day surgery:
- Active lifestyle limited only by a painful joint
- Healthy body weight
- Generally younger than 65
- In good physical condition without serious medical issues
- Motivated patient with a good support system at home
Who is NOT a Candidate for Same-Day Joint Surgery?
If you meet any of the following conditions, you are unlikely to be a candidate for outpatient joint replacement surgery:
- BMI greater than 35
- You have a serious medical condition such as heart disease, congestive heart failure, poorly controlled diabetes, chronic lung disease, chronic kidney disease, sleep apnea, or you take daily steroid medications.
- You have balance problems or chronic neurological disease, or have had difficulty walking before surgery.
- You live alone and have no one to care for you post-operatively.
Ambulatory surgical centers give patients more options in choosing the location, quality and overall cost of their orthopedic care. But careful patient selection for outpatient joint replacement is critical to its success.
Every patient’s priorities and expectations are unique, but if your surgery goals are to get in, get out and get on with your life, then outpatient joint replacement surgery might be the right choice for you.
OrthoEdge’s specialists will tailor a minimally-disruptive joint replacement surgery plan to meet your condition, cost and recovery needs. We’ll also design a personalized rehabilitation program to meet you where you are and get you where you want to go – back to a mobile life.