Speaker: Surgeons need to consider several factors in transition to same-day surgery
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Although same-day surgery may be safely performed in select patients and with experienced surgical teams, there are controversies that need to be addressed, according to a presenter here.
In his keynote address at the Current Concepts in Joint Replacement Winter Meeting, Kevin J. Bozic, MD, MBA, noted previously published literature comparing inpatient and outpatient total joint hip and knee surgery showed no differences in the rates of operative time, readmissions, reoperation, complications or patient-reported outcomes.
However, it is important for surgeons to consider patient selection criteria, including patient age, BMI, baseline functional status and comorbidities, when it comes to same-day discharge, according to Bozic.
“In our experience, mental health is probably a more significant predictor of ability to discharge day of surgery than physical health,” Bozic said in his presentation.
He added patient expectation and social support are also “extremely important.”
“If you have a patient who lives alone on the second or third floor, it is going to be difficult to discharge that patient on the day of surgery,” Bozic said.
The optimal multimodal pain management strategy and whether patients should receive a single dose of antibiotics preoperatively or be discharged with oral antibiotics continue to be controversial as well, according to Bozic.
Finally, he said the financial impacts of same-day discharge are significant but vary depending on whether it is from the perspective of the health system or the payer. Although payers may experience significant benefits with the use of same-day discharge, Bozic noted health systems may see a reduction in margin with implementation.
“Going just from the inpatient to the [hospital outpatient department] HOPD setting, we had about a 40% reduction in margin on these cases,” Bozic said. “If you look at shifting from the inpatient to the ASC setting, you are looking at about a 70% reduction in margin, not to mention the fact that most health systems do not own their own ASCs.”
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Bozic KJ. Making a safe transition to outpatient total joint arthroplasty. Presented at: Current Concepts in Joint Replacement Winter Meeting; Dec. 8-11, 2021; Orlando (hybrid meeting).
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