Outpatient Joint Replacement Surgery: It's Ready, but Are You?

Sandra Gittlen, September 1, 2016

The procedures are becoming more viable in an outpatient setting, but only if the right patients and resources are involved.

This article first appeared in the September 2016 issue of HealthLeaders magazine.

Elie Joseph Chidiac, MD
Elie Joseph Chidiac, MD

Theodore Stringer, MD, a surgeon with Colorado Springs Orthopaedic Group, a board-certified orthopedic physician practice with subspecialty care offerings such as sports medicine, spine, and trauma, is laying the groundwork to begin offering outpatient joint replacement surgery. He expects payers to mount pressure to shorten hospital lengths of stay, but says of outpatient joint replacement, "I didn't want to be the first person [to do outpatient joint replacement surgeries], but I also don't want to be the last."

Stringer has studied the logistics of starting this venture, met with peers across the country who already provide these services, and surveyed interest from his own team, and realized that missing any key ingredient in the setup of offering outpatient joint replacement surgery could result in poor patient outcomes.

For outpatient joint replacement surgeries to be successful, the facility must have anesthesiologists skilled at regional blocking anesthesia, a 24-hour medical team must be in place for patient follow-ups and emergencies, and most important, the practice must be focused on patient selection and preoperative education and preparation.

"Outpatient joint replacement is not an option for a majority of patients, so we are preparing and trying to find the right patients," Stringer says.

The concept of outpatient joint surgery, which primarily includes total hip replacement, total knee replacement, and partial knee replacement, is not yet palatable to many surgeons. In fact, of the four arthroplasty specialists in CSOG's 18-person practice, only Stringer himself is currently on board and only wants to perform total knee replacements to start.

Scott Bergman, MBA, board member of the New Jersey Association of Ambulatory Surgery Centers and administrator at Cherry Hill, New Jersey–based Millennium Surgical Center, an advanced outpatient surgical center focusing on orthopedics, spine, pain management, and podiatry, says outpatient total knee replacements, which his multispecialty surgery center has been doing since 2014, are "profitable procedures, so you'd like to do more."

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