Outpatient Joint Surgery Offers Some Clear Advantages. But Is It Right For You?
Over the past decade, the average hospital stay for total joint replacement patients has decreased from five days to typically less than two. Now, because of revolutionary advances in surgical techniques, anesthesia medications, pain management protocols, and customized physical therapy regimens, some patients are able to have outpatient joint surgery.
There are clear benefits to returning home on the same day as your surgery, including quicker recovery and significant cost savings. But it’s not appropriate for everyone. We’ll help you consider the advantages and disadvantages of outpatient joint surgery, and review if you’re a candidate.
Where Do These Surgeries Take Place?
Most outpatient joint procedures take place in accredited ambulatory surgical centers (ASC). These highly specialized health care facilities focus on providing same-day surgical care with increased efficiency. Your surgeon is credentialed to operate in both hospital and ASC settings.
Outpatient knee replacement and hip replacement procedures use the same technology and implants as traditional joint replacement surgery.
What are the Benefits?
- Reduced risk of infection. By choosing outpatient surgery, you avoid exposure to infectious diseases sometimes associated with hospital settings. The estimated national average of surgical site infection rates at hospital facilities is around 2%, or 20 per 1,000 patients. ASC infections rates are six times lower than hospital outpatient surgery departments. The infection rates at single specialty ASCs that perform only one type of surgery are even lower.
- Reduced out-of-pocket cost. ASCs offer high-quality, comprehensive total joint replacement surgery at a lower cost than hospitals. On average, patients pay less at an ASC compared to the identical total hip or total knee procedure performed in a hospital environment. Co-pays and co-insurance costs should be lower. If you have a high insurance deductible or premium, you may save a substantial amount of money. By avoiding the cost of overnight hospital care, your savings could be as much as 40%.
- Higher patient satisfaction. The narrower scope of procedures performed at ASCs allows for more specialized care and high patient satisfaction due to smaller and more personalized teams. According to Medicare.gov, the average hospital gets a 3 out of 5 star rating (approximately 60%). According to the Ambulatory Surgery Center Association, the average ASC sees a 92% satisfaction rate among outpatient surgery patients.
- Safe, low-stress environment. Surgery centers are free-standing facilities that offer a pleasant, low-stress setting with convenient parking, strictly enforced quality control processes, and highly personalized care. Surgical delays are limited because ASCs have better control over their scheduling. (In a hospital, your elective surgery can be “bumped” because of emergency room needs.)
- Faster recovery. Surgeries at ASCs are often shorter and getting home quickly means you’re on an faster road to recovery. People who are comfortable at home heal quicker and do better than those who are not in their own environment.
- Recover at home. You’ll be able to rest and heal in the comfort of you own home. You’ll get to sleep in your own bed, undisturbed by staff checks or other interruptions that are part of the hospital setting. You’ll also be able to eat your own food.
- You control your medications. You won’t have to wait for a nurse to bring you your medications. You’ll be in charge of your own pain medication regimen.
What are the Potential Disadvantages?
- Less medical supervision. When recovering at home, most patients do not have direct medical supervision, which could be a disadvantage in the first days after a joint replacement procedure. Only people who have a low risk of surgical complications are considered good candidates for outpatient procedures.
- Recovering at home requires strong family support. Patients are given extensive instructions for managing their recovery process at home, but it is critical that they have family members there who can provide assistance.
- Concerns about pain management. The amount of pain and discomfort a patient experiences after surgery depends on multiple factors. We use evidence-based multimodal pain management techniques that facilitate a quicker recovery and return to mobility. Open communication with your OrthoEdge physician is an important part of helping us manage your pain relief.
Does Medicare Cover Outpatient TotalJoint Replacements?
In 2018, the Centers for Medicare and Medicaid Services (CMS) approved payment for outpatient knee replacements. If your doctor believes you are a candidate for outpatient surgery, the cost of your knee surgery would be covered under Part B. In 2019, CMS removed total hip arthroplasty (THA), also known as hip replacement surgery, from the Inpatient-Only List, allowing THAs to be performed in a hospital-based outpatient department (HOPD).
Who Is a Good Candidate for Outpatient Surgery?
Have you been told you need joint replacement surgery? If you meet these important criteria, you could be a good candidate for same-day surgery:
- Active lifestyle limited only by a painful joint
- Healthy body weight
- Generally younger than 65
- In good physical condition without serious medical issues
- Motivated patient with a good support system at home
Who is NOT a Candidate for Same-Day Joint Surgery?
If you meet any of the following conditions, you are unlikely to be a candidate for outpatient joint replacement surgery:
- BMI greater than 35
- You have a serious medical condition. If you have heart disease, congestive heart failure, poorly controlled diabetes, chronic lung disease, chronic kidney disease, sleep apnea, or you take daily steroid medications, you should not get outpatient surgery.
- You have balance problems or chronic neurological disease, or have had difficulty walking before surgery.
- You live alone and have no one to care for you post-operatively.
Ambulatory surgical centers give patients more options in choosing the location, quality and overall cost of their orthopedic care. But careful patient selection for outpatient joint replacement is critical to its success.
Every patient’s priorities and expectations are unique. If your surgery goals are to get in, get out and get on with your life, then outpatient joint replacement surgery might be the right choice for you.
OrthoEdge’s specialists will tailor a minimally-disruptive joint replacement surgery plan to meet your condition, cost and recovery needs. We’ll also design a personalized rehabilitation program with a physical therapist to meet you where you are and get you where you want to go – back to a mobile life.