Even with the significant advances in total hip and knee replacement surgery over the past couple of decades, for the vast majority of patients, it still means an inpatient stay of one to three days before going home from the hospital, and then weeks of recuperation. But what if there was an option to have joint replacement surgery and go home the same day? Most of us would jump at the chance (well, maybe not jump, but signal approval) to avoid a hospital stay and return home in hours and begin the healing process.
Well, outpatient hip and knee replacement surgery is now a reality. While nationally, the trend is growing, it is still a procedure that is reserved exclusively for physicians and groups that have a demonstrated history of superior outcomes. Mississippi Sports Medicine and Orthopaedic Center (MSMOC) has partnered with Blue Cross & Blue Shield of Mississippi (BCBSMS) as the first and only surgical clinic in the state to perform total knee and hip replacement surgery in an outpatient ambulatory setting.
According to MSMOC Orthopaedic Surgeon Dr. Jeff Almand, there are a number of key factors that have made it possible for his practice to offer qualifying patients the option to have hip or knee replacement surgery on an outpatient basis.
“Advanced, minimally-invasive surgical techniques make for much smaller incisions reducing blood loss, Almand notes. “Our use of tranexamic acid also helps prevent prolonged bleeding by slowing the breakdown of blood clots, reducing the need for blood transfusions in from 33% of patients to 1%.” Improved pain management is another way MSMOC physicians make outpatient hip and knee surgery a viable option for some patients. “We have developed very successful pain management techniques, including preemptive analgesia, which involves administering pain medications prior to surgery to block pain from several pathways – from the brain to the location of surgery,” continues Almand. “We also give pain medications by mouth after the surgery before the first medications wear off to minimize patient discomfort.”
Further, the surgery center’s rapid recovery protocols call for the patient to see a physical therapist weeks prior to the surgery for a pre-habilitation process. Then the patient sees a physical therapist at our outpatient surgery center for the first time on the day of surgery and the following day at home. The therapist works with the patient at home for five days and then the patient transitions to outpatient therapy. “We have seen a reduction in complication rates from infections and blood clots in patients receiving the outpatient surgery at our center,” says Almand. “In fact, with over 300 outpatient surgeries completed so far, we have had no complications and our patients love going home the same day to recover in the comfort of their own homes.”
It turns out that there is a significant financial benefit of having outpatient hip or knee replacement surgery. The cost of care at the outpatient surgery center is about 1/3 of the cost of having the surgery as an inpatient at the hospital. All patients qualify for an additional benefit of a reduced deductible and co-insurance by selecting outpatient surgery at MSMOC’s Madison Outpatient Surgery Center, recognized by Blue Cross Blue Shield as the state’s only outpatient Orthopaedic Center of Excellence.
Before a patient can be considered for a knee or hip replacement in the outpatient setting, they must meet specific criteria related to their overall health and risk factors.
Dr. Jeff Almand, spoke on the safety of having the procedure performed in an outpatient versus inpatient setting, “The procedure is very safe. The patient goes through a thorough screening process; we do a home visit prior to surgery to make sure the home is safe and the patient is fully educated on what to expect post surgery. And, with five total joint surgeons, we always have a physician on call should patients have a question or need assistance.”
“Our advances in patient outcomes, satisfaction and safety for hip and knee replacement were the foundation for our move to provide the surgeries in an outpatient setting,” adds Almand. “Taking this step of offering individuals a choice for where their elective surgery is performed increases patient satisfaction and reduces costs, not only for individuals, but for their employers.”
Outpatient total knee and hip replacement surgery is a game-changer in the delivery of orthopaedic care and promises to help pave the way for a new national standard.
Mississippi Sports Medicine and Orthopaedic Center has clinic locations in Jackson, Flowood, Madison, Brookhaven, Cleveland and Yazoo City. For more information about outpatient total hip and knee surgery at MSMOC, call 601-354-4488 or visit www.mississippisportsmedicine.com.
Jeff Almand, M.D., Orthopaedic Surgeon, received his Doctor of Medicine degree from Tulane University in New Orleans. His professional training in orthopaedic surgery includes an orthopaedic surgery residency at Duke University Medical Center, and a Fellowship in total joint replacement in Indianapolis with the University of Indiana and Indiana Orthopaedic Hospital. He is Board Certified by the American Board of Orthopaedic Surgery.