Opioid-sparing enhanced recovery after surgery pathway for Medicare patients undergoing total joint replacement may promote early discharge, according to research presented at the American Academy of Orthopaedic Surgeons 2019 Annual Meeting in Las Vegas, March 12-16.
Researchers captured retrospective chart review data were captured for 645 consecutive Medicare patients who underwent primary inpatient total knee replacement (337 patients) or total hip replacement (308 patients) between June 1, 2015, and Nov. 16, 2017. All patients followed a procedure-specific ERAS protocol involving presurgical physical, medical and social optimization, assistance with medical issue and modifiable risk factor stabilization, postsurgical rehabilitation training and the development of a social support network.
The ERAS pathway included Exparel, a bupivacaine liposome injectable suspension.
Key findings:
1. Eighty-four percent of patients were discharged home the same day after joint replacement without home services.
2. The researchers found 84.2 percent did not require any additional opioid prescriptions after the initial seven day prescription at discharge. Nationwide, 38 percent of knee replacement patients still take opioids two months postoperatively.
3. Almost all — 98.9 percent — of patients reported they would recommend the surgical facility "very much" or "a good amount," while 98.3 percent reported high satisfaction with their pain management. Slightly more than 97 percent were highly satisfied with the education and communication they received.
"Our findings suggest that potential exists for Medicare-insured patients to undergo safe and successful TKA or THA procedures as outpatient surgery with same-day discharge to home. Since the completion of our study, more than 90 percent of patients safely and comfortably go home the day of surgery," said Grants Pass, Ore.-based Paragon Orthopedic Center surgeon James Van Horne. Dr. Van Horne performed the surgeries and authored the analysis.