Discharge the Day of Surgery: Strategies to Optimize and Discharge Criteria

Abstract

In an era of cost containment and value-based healthcare, hip and knee surgeons have renewed focus on outpatient joint replacement and the benefit of rapid recovery protocols as an avenue for improvement in the delivery of care and patient experience. Payors are also seeing value in outpatient hip and knee arthroplasty, evidenced by removal from the inpatient-only Medicare list. With improved pain management, anesthesia protocols, surgical techniques, physical therapy, and implant designs, many surgeons are able to adopt outpatient arthroplasty into their practices to varying degrees. In order for outpatient arthroplasty programs to be successful, safe, and reproducible, standards need to be established for the preoperative, intraoperative, and postoperative episodes of care. The same-day surgery process starts at the first patient visit and continues through discharge home. The purpose of this chapter is to highlight the many facets of a successful same-day discharge program that has been developed at the Steadman Clinic with a specific focus on patient optimization and discharge criteria, giving the reader a playbook to implement such a program. This chapter will be divided to highlight areas of importance at the preoperative patient visit, techniques to optimize surgical outcomes, and criteria for postoperative discharge.