Is Outpatient Arthroplasty Safe? A Systematic Review

Jaibaji, Monketh; Volpin, Andrea; Haddad, Fares S.; Konan, Sujith

doi:10.1016/j.arth.2020.02.022

Cited by 76 publications

(39 citation statements)

References 60 publications

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“…Over the past decade, there has been increasing interest in performing primary hip and knee arthroplasty in the outpatient setting, with these procedures having been successfully performed during the past decade by a select group of surgeons and institutions with multidisciplinary care team coordination, standardized perioperative protocols, discharge planning, and careful patient selection [32e46]. Multiple systematic reviews have reported that outpatient arthroplasty is safe and effective [43,47,48]. In 2018, the American Association of Hip and Knee Surgeons, Hip Society, Knee Society, and American Academy of Orthopaedic Surgeons put forth a position statement supporting the notion that some primary hip and knee arthroplasties can be appropriately and safely performed in the outpatient setting with discharge on the day of surgery provided strict preoperative patient selection, standardized perioperative protocols, safe discharge plans, and sufficient practitioner and surgeon experience are maintained [49].…”

mentioning

confidence: 99%

After the COVID-19 Pandemic: Returning to Normalcy or Returning to a New Normal?

Zeegen

Yates

Jevsevar

2020

The Journal of Arthroplasty

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The novel coronavirus, severe acute respiratory coronavirus 2 (SARS-CoV-2), pandemic has delivered a profound and negative impact on the United States. The suspension of elective surgeries including arthroplasty will have a lasting effect on all stakeholders including patients, physicians, and healthcare organizations within the US healthcare system. Resumption of elective hip and knee arthroplasty will need to be carefully focused. The purpose of this work is to address potential strategies, concerns, and regulatory barriers in restarting elective hip and knee arthroplasty in the United States.

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mentioning

confidence: 99%

After the COVID-19 Pandemic: Returning to Normalcy or Returning to a New Normal?

Zeegen

Yates

Jevsevar

2020

The Journal of Arthroplasty

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“…37 Although the uptake of outpatient arthroplasty in Australia has been slower than in the USA, 38 discussions about healthcare reform and a growing body of evidence showing its safety in certain patient populations mean that it may become a viable way to reduce the growing financial burden for the predicted increase in TKR surgery over the next decade. 39 Referral rates to extended inpatient rehabilitation in Australia are high. It is estimated that approximately 40% of patients who are privately insured and 20% of patients in the public sector were referred to inpatient rehabilitation following TKR surgery in 2014.…”

Section: Length Of Stay Outpatient Arthroplasty and Discharge Destinmentioning

confidence: 99%

Changes to rehabilitation after total knee replacement

Sattler¹,

Hing²,

Vertullo³

2020

Aust J Gen Pract

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“…57 Over the past decade, considerations were moving forward to ambulatory surgery centers 58 and outpatient sitting arthroplasties. 59 Multiple systemic reviews have reported these methods as safe and effective. 60…”

Section: Rationalementioning

confidence: 99%

Perspectives and Consensus among International Orthopaedic Surgeons during Initial and Mid-lockdown Phases of Coronavirus Disease

Jerome¹,

Mercier²,

Mudgal

et al. 2020

Journal of Hand and Microsurgery

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AbstractWith a lot of uncertainty, unclear, and frequently changing management protocols, COVID-19 has significantly impacted the orthopaedic surgical practice during this pandemic crisis. Surgeons around the world needed closed introspection, contemplation, and prospective consensual recommendations for safe surgical practice and prevention of viral contamination. One hundred orthopaedic surgeons from 50 countries were sent a Google online form with a questionnaire explicating protocols for admission, surgeries, discharge, follow-up, relevant information affecting their surgical practices, difficulties faced, and many more important issues that happened during and after the lockdown. Ten surgeons critically construed and interpreted the data to form rationale guidelines and recommendations. Of the total, hand and microsurgery surgeons (52%), trauma surgeons (32%), joint replacement surgeons (20%), and arthroscopy surgeons (14%) actively participated in the survey. Surgeons from national public health care/government college hospitals (44%) and private/semiprivate practitioners (54%) were involved in the study. Countries had lockdown started as early as January 3, 2020 with the implementation of partial or complete lifting of lockdown in few countries while writing this article. Surgeons (58%) did not stop their surgical practice or clinics but preferred only emergency cases during the lockdown. Most of the surgeons (49%) had three-fourths reduction in their total patients turn-up and the remaining cases were managed by conservative (54%) methods. There was a 50 to 75% reduction in the number of surgeries. Surgeons did perform emergency procedures without COVID-19 tests but preferred reverse transcription polymerase chain reaction (RT-PCR; 77%) and computed tomography (CT) scan chest (12%) tests for all elective surgical cases. Open fracture and emergency procedures (60%) and distal radius (55%) fractures were the most commonly performed surgeries. Surgeons preferred full personal protection equipment kits (69%) with a respirator (N95/FFP3), but in the case of unavailability, they used surgical masks and normal gowns. Regional/local anesthesia (70%) remained their choice for surgery to prevent the aerosolized risk of contaminations. Essential surgical follow-up with limited persons and visits was encouraged by 70% of the surgeons, whereas teleconsultation and telerehabilitation by 30% of the surgeons. Despite the protective equipment, one-third of the surgeons were afraid of getting infected and 56% feared of infecting their near and dear ones. Orthopaedic surgeons in private practice did face 50 to 75% financial loss and have to furlough 25% staff and 50% paramedical persons. Orthopaedics meetings were cancelled, and virtual meetings have become the preferred mode of sharing the knowledge and experiences avoiding human contacts. Staying at home, reading, and writing manuscripts became more interesting and an interesting lifestyle change is seen among the surgeons. Unanimously and without any doubt all accepted the fact that COVID-19 pandemic has reached an unprecedented level where personal hygiene, hand washing, social distancing, and safe surgical practices are the viable antidotes, and they have all slowly integrated these practices into their lives. Strict adherence to local authority recommendations and guidelines, uniform and standardized norms for admission, inpatient, and discharge, mandatory RT-PCR tests before surgery and in selective cases with CT scan chest, optimizing and regularizing the surgeries, avoiding and delaying nonemergency surgeries and follow-up protocols, use of teleconsultations cautiously, and working in close association with the World Health Organization and national health care systems will provide a conducive and safe working environment for orthopaedic surgeons and their fraternity and also will prevent the resurgence of COVID-19.

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Is Outpatient Arthroplasty Safe? A Systematic Review

Cited by 76 publications

References 60 publications

After the COVID-19 Pandemic: Returning to Normalcy or Returning to a New Normal?

After the COVID-19 Pandemic: Returning to Normalcy or Returning to a New Normal?

Changes to rehabilitation after total knee replacement

Perspectives and Consensus among International Orthopaedic Surgeons during Initial and Mid-lockdown Phases of Coronavirus Disease

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