Total Knee Replacement Outpatient Surgery Abraham Abdo, MD - - PDF document

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Total Knee Replacement Outpatient Surgery Abraham Abdo, MD - - PDF document

Mar 05, 2023 303 likes •447 views

3/2/2018 Total Knee Replacement Outpatient Surgery Abraham Abdo, MD Orthopedic Surgery 2698 N. Galloway Ave Mesquite, TX 75150 Modern Era of Total Knee Arthroplasty began with Gunston in 1971 1 3/2/2018 Many of the problems encountered

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Total Knee Replacement

Outpatient Surgery

Abraham Abdo, MD Orthopedic Surgery 2698 N. Galloway Ave Mesquite, TX 75150

Modern Era of Total Knee Arthroplasty began with Gunston in 1971

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Many of the problems encountered with early designs have been defined and appropriate solutions have been identified.

New designs took into consideration problems with

  • Patellofemoral pain
  • Alignment
  • Tracking
  • Polyethylene wear
  • Instrumentation

Arthritis affects about 40 million Americans, 1 in 8 people. 700,000 TKA are performed annually.

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Painful Arthritic Knee Joint that failed to respond to conservative therapy that includes:

  • Medications
  • Physical Therapy
  • Modification of Activities
  • Injections
  • Arthroscopy

Surgical Procedure

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Past 20 years duration of hospitalization for TKA in U.S. has decreased from 9 to 4 days. The hospital cost for TKR has

  • increased. Therefore, reduction

in length of stay remains an important target for cost containment.

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Pain management and anesthesia advancement has played a big role in transitioning total joints to outpatient setting.

Projected Outpatient Surgery for Joint Replacement

  • 2016: 15%
  • 2018: 25%
  • 2020: 32%
  • 2022: 37%
  • 2024: 43%
  • 2026: 51%

10 20 30 40 50 60 2016 2018 2020 2022 2024 2026

Beginning of 2018, CMS removed Total Knee Replacement from the inpatient only list.

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  • Reimbursement rate of $12,384

for inpatient and $10,122 for

  • utpatient surgery would result in

18% decrease in reimbursement for providers.

  • A saving of $311 million for

Medicare. Pathway to Outpatient TKR

  • Preoperative Screening

‐ comorbidities

  • Patient Education & Expectation

Alignment

  • Pain Management & Early Mobilization
  • Minimization of Blood Loss

ASA Class 1‐3 BMI 35 or less Age 70 years old or younger

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Inpatient Certification

  • High Risk for DVT

HX A FIB Mechanical Heart Valve HX VTE in past 3 months

  • One or more of the following comorbidities:

DM, BMI>35, Cardiac: CAD, HF, AMI COPD, Sleep Apnea, Dementia, Falls

10.2 % of outpatient TKR procedures were readmitted within 30 days Compared to 6.6% of the inpatient procedure group.

  • Will our patient want this?
  • Are the physicians on board?
  • Are the facilities appropriate?
  • Limitations of the staff?
  • How will we select patients?
  • What will happen before, during, and after?
  • Are we confident in our value proposition and minimum reimbursement

rates?

  • Marketing?
  • Evaluate our successes and failures.
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In Summary

Whether our goal is to reduce length of hospital stay or eliminate it, proper planning must be done to insure patient safety and success.