Total joint replacements were traditionally hospital-based procedures requiring several days to recovery. However, minimally invasive surgical technique, implants and pain management now allow select patients to undergo outpatient total joint replacements — an advancement that even surprises some surgeons.
"If you would have asked me two or three years ago [if] we would be talking about outpatient surgery for joint replacement, I would [have said] you're crazy, but now I think it's absolutely the future," said Peter Sharkey, MD, an orthopedic surgeon at Philadelphia-based Rothman Institute.
SwiftPath aims to help more orthopedic surgeons take their cases outpatient during a roundtable and bioskills lab event at MemorialCare Outpatient Surgical Center in Long Beach, Calif., on Feb. 24, 2017. The event is titled "SwiftPath: Launching the Triple Aim."
"In spite of the proven efficacy joint replacement, many patients are not happy with their outcomes," said Craig McAllister, MD, co-founder of SwiftPath and a presenter at the event. "It is never easy for surgeons to change their methods. Nonetheless, it turns out that minimally invasive techniques, modern pain management, longer-acting periarticular injections and patient engagement really do work.. Take away the blood loss, opiate related adverse events, IVs, Foley catheters, drains and other outdated interventions, and many joint replacement patients actually do better recovering at home."
Dr. McAllister and Chairman of Orthopedics at Bronx-Lebanon Hospital Center Health Care System in New York City Ira Kirschenbaum, MD, presented a study at the 2015 American Association of Hip and Knee Surgeons and 2016 American Academy of Orthopaedic Surgeons annual meetings of 200 knee replacements and reported the successful outcomes using the SwiftPath Method for joint replacements. In May 2016, SwiftPath partnered with Surgical Care Affiliates to incorporate the technology within SCA's surgeon network.
"Our center is the latest of the MemorialCare/SCA joint venture in Southern California boasting state-of-the-art operating rooms equipped with the latest technologies available for outpatient orthopedic surgeries including total joint replacement," said James Hogan, CEO of MemorialCare Surgical Center. "Our orthopedic team was carefully selected when the facility was opened, so we were able to assemble a team with the best and the brightest people with years of experience supporting orthopedic surgeons in the operating room."
Mr. Hogan said SwiftPath helped the ASC streamline processes and surgeons at the center used the program to provide a lower cost, more comfortable setting for care. "Patients are extremely happy being discharged the same day of surgery to the comfort of their own homes. The program has provided demonstrations of intraoperative techniques, postoperative pain management, and has greatly reduced prescribing narcotics to the total joint patients," said Mr. Hogan.
Now SwiftPath is embarking on a surgeon educator program to train others on providing quality outpatient joint replacements. The program covers the didactic and clinical aspects of care that the SwiftPath Protocol focuses on, allowing surgeons to instruct other surgeons on minimally invasive, outpatient joint replacements.
"The SwiftPath Program helps my patients by proactively addressing potential problems or issues and treating them before they become a problem," said Trong Nguyen, MD, a joint replacement specialist in Orange County, Calif. "Being able to engage the patient in their own care makes for a much more involved patient, a much more satisfied patient, with better results and outcomes. I would estimate somewhere between 20 to 25 [percent] and 40 percent of my patients would qualify as outpatient joint replacements using this program."
In addition to the bioskills lab, the event at MemorialCarewill include formal JointCamp instructor certifications. In the evening, the round table discussion sessions cover surgical technique, pain management, cloud-based patient engagement and a pathway selection application that helps predict same-day discharge. Dr. McAllister will present on "Using the Cloud to improve the Surgeon's Life" to close out the event. Surgeons will leave equipped with the knowledge and tools to move forward with outpatient total joints, including surgical technique, periarticular injections, multimodal pain management and patient education.
"Being a private practice surgeon in a busy practice, it's hard to find time to do anything. Also, you can give them (patients) a lot of information, but when they go home, and they say, 'I don't really have the information with me, it's a little bit scary'," said Andrew Wassef, MD, a joint replacement specialist who performs cases at MemorialCare Surgery Center. "Having my SwiftPath Surgeon Authored Guide provides my patients with all the information they need before surgery. After surgery, if they need to look back at it, they have notes, and they understand the process. That makes me more comfortable, but most importantly, it makes the patient more comfortable, and the family members taking care of the patient much more comfortable."