Doctor Touts Benefits of Out-Patient Joint Surgery

Maurice Cates, M.D., an orthopedic surgeon with Mid-Atlantic Permanente Medical Group, along with the writer for Northern Virginia Magazine, Ryan Basen, makes the case for getting joint replacement surgery cases back to their homes within 24 hours.

Cates recalls two decades ago when such patients stayed in the hospital for 11 days and, he writes, often suffered complications due to inactivity. Now, he insists, every patient who meets criteria for surgery at a freestanding outpatient center is home the same day or the day after surgery. That, he says, is because outpatient teams address potential obstacles before surgery by screening to ensure patients have no other serious health problems. After surgery, he says that the medical staff manages pain by following research-supported protocols and encourages early walking.

Early discharge from the hospital following joint replacement surgery is not a new development. Cates and Basen point out that at least as far back as 2012, 9.7% of knee replacements and 2.9% of hip replacements conducted at hospitals were done in designated outpatient settings.

Cates makes the point that patients are more likely to avoid complications when they move around soon after surgery and start rehab at home. He believes that patients are more comfortable at home, where they can participate in home-based physical therapy and avoid complications such as infections that sometimes arise during hospitalization. Home rehab has generated comparable results to in-person rehab, he wrote.

Cates and Basen write that home rehab also lowers costs. According to them, hospital care and post-acute care constitute about three-quarters of knee and hip replacement costs and undergoing the surgery outpatient will help address a large public health burden. “My practice began conducting full knee and hip replacements in outpatient centers earlier this year, ” wrote Cates. “This is value-based, high-quality care that more patients should explore.”