A healthy living blog from Marshfield Clinic Health System

Same-day surgery with total joint replacements new option for patients

doctor examines a patient's knee to assess same-day discharge option

Same-day discharge now an option for ideal candidates after total joint replacements.

Same-day discharge for total joint replacement surgery is becoming more common. Until recently, most patients who need shoulder, knee or hip joint replacements have a one to two day hospital stay, depending on the complexity of the replacement and their recovery.

Some medical facilities were using same-day discharge on total joint replacements prior to 2020. However, this practice has increased significantly with impact of COVID-19 on hospital resources. Across the country, same-day discharges have high-quality outcomes, low complication rates and positive patient experiences for individuals who need joint replacement surgery.

“Patients like the option of same-day discharge after hip or knee replacement,” said Dr. David Simenstad, orthopedic surgeon for Marshfield Clinic Health System. “For ideal candidates, same-day discharge for arthroplasty is safe and effective. They have lower readmission and complication rates than patients that stay overnight in the hospital for non-same-day discharge replacements. Many like the fact they can go to their own home after surgery.”

Same-day discharge not right for all patients

Your surgical care team will work with you to identify if you are an ideal candidate for same-day discharge. “Key factors we consider when evaluating for same-day discharge are medical history and physical examination,” Simenstad said. “But some of the most important criteria is patient motivation and a good support system at home.”

Age, weight, general good health and complexity of replacement are some of the factors surgeons weigh to assess ideal candidates for same-day discharge. Individuals who have significant cardiac or respiratory disease or other untreated conditions will follow a traditional joint replacement recovery with hospital admission, but most of these will only stay one night in the hospital.

Planning and safety are key

Patients who are same-day discharge surgery candidates will receive preoperative education, and testing and consultations with their orthopedic surgeon and care team. Patients should be motivated and committed to optimize their health, including exercises to increase physical strength before surgery.

Surgery is scheduled for earlier in the day to allow as much time as possible to recover from anesthesia. This timing also allows more time to meet postoperative milestones in order to go home the same day. Many patients are ready for discharge within 6 hours of surgery to go home. You need to be able to walk, sit and stand and navigate stairs independently or with minimal assistance. In addition, you need to show stable vital signs and have your pain controlled with prescribed medication. You also need to have a caregiver at home.

New general anesthesia techniques allow less nausea and quicker recovery from anesthesia. In this approach, the effects of the anesthesia wear off faster. You can be mobile sooner to begin the physical therapy process earlier in the day. “Light headedness, pain control and nausea are often reasons that delay discharge,” Dr. Simenstad said. “We prep the patients to make sure they are adequately hydrated and monitored. We also work with patients in recovery to ensure their needs are met and a safe discharge can occur.”

Follow up support needed in recovery

The day after discharge, a member of your orthopedic care team will check in on you to monitor recovery and provide support if needed. In recovery, you will focus on regaining mobility and building strength. This time investment in education, patient motivation and at home support is integral to healing. Rehabilitation continues after discharge, including physical therapy appointments soon after discharge. You will have at-home exercises and follow-up visits with your surgeon based on your needs and goals.

If you are experiencing pain and mobility issues, contact the orthopedic team at Marshfield Clinic Health System to discuss your total joint replacement options. Up to 50% of patients can now go directly home the day of surgery. Check with your orthopedic provider to see if that is right for you.

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