Since entering private practice nearly five years ago, orthopedic surgeon Stephen Kayiaros, MD, has seen the industry significantly change.
"One of the key changes I have seen is the drive to performing joint replacements in the outpatient setting," says Dr. Kayiaros of University Orthopedic Associates in Somerset, N.J. "Outpatient total joints have been a hot topic in the orthopedic arena in the last two to three years."
A historically inpatient procedure, rapid recovery protocols have pushed these procedures to the outpatient setting, where patients can recover sooner and get back to their daily lives. Total joint replacement is an intensive procedure and therefore is one of the later specialties to go outpatient, with Dr. Kayiaros noting the procedure has typically been inpatient due to the procedures' duration, potential complications and patients' co-morbidities.
"Patients used to be in the hospital anywhere from two to three nights to even the later part of the week," Dr. Kayiaros says. "With developing better protocols, younger, healthy patients undergoing hip and knee procedures are doing so well, which is where the concept of doing this in an outpatient basis comes about."
Controlling a patient's pain is a crucial element of performing outpatient TJRs, especially as patient satisfaction scores increasingly dictate reimbursement. Total hips were a "seamless" transition as more surgeons are performing these procedures through an anterior approach. Performing total knee replacement on an outpatient basis has been more challenging, with new pain management techniques taking hold.
"The biggest pain management advancements have been in total knee replacements," Dr. Kayiaros explains. "We have revolutionized the way we do knee replacements by utilizing nerve blocks, which block a patient's perception of pain."
Nerve blocks allow patients to function following the procedure and undergo physical therapy, while also reducing the need for narcotics and the negative side effects associated with opioid use such as nausea and vomiting.
When Dr. Kayiaros' patients leave following a TJR procedure, they use ON-Q, a non-narcotic elastomeric pump, to manage pain. The pump delivers a regulated flow of local anesthetic to a patient's surgical site or in proximity to the nerves, which provides targeted pain relief for up to five days.
University Orthopedic Associates coordinates the entire episode of care from anesthesiology to the home health agency that sees a patient discharged to home.
"Everyone who is in touch with the patient should have a seat at the table," Dr. Kayiaros says. "If a patient doesn't have the sense that everyone knows what's going on, the patient will not have the security and confidence that their surgery and post-op recovery is going to be successful."
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