just in case you missed the considerations for exclusion for outpatient total knee arthroplasty criteria discussed on the podcast: ( it's a lengthy one)
- Hgb A1x >7.5
-Solid Organ Transplant
-Chronic Renal disease stage 3 or greater
-BMI greater than 40 with additional comorbidity/risks identified
-Cardiopulmonary event in last year ( acute MI, stent placement, acute CHF
-Sleep Apnea ( OSA)
-Tobacco users not willing to utilize nicotine replacement therapy ( pathches, gum) and participate in smoking abstinence
-Bleeding disorders. Patient on chronic anticoagulation requiring post-surgical reimplementation of anticoagulants such as Coumadin, Eliquis, Lovenox, heparin, Xarelto, Arixta, Pradaxa
-Patients who post-discharge needs may include skilled nursing facility placement or inpatient rehab. Special consideration for those with disabilities (amputees, partial paralysis, psych illness), fail and elderly person that have additional conditions that preclude them from caring for themselves and require skilled care in the early postoperative period that cannot be provided as an outpatient or in-home service
-Chronic Opioid Consumption
-Malnutrition: total lymphocytes <1500 cell/mm, Albumin <3.5g/dl, transferrin level <200mg/dl
-ASA of 4 or greater assessed by anesthesia. ASA 3 needs thorough assessment of patients risks and co-morbidities
-Anemia, Baseline Hgb < 11
-HTN BP greater than 140/90 and on medications
-COPD if on regularly scheduled medications and/or inhalers
-Cancer/immunocompromised
-Positive MRSA Screening with vancomycin treatment
-Patients post-acute setting too great of distance from emergent medical care
Episode Reference List
Berend KR, Lombardi AV Jr, Berend ME, et al. The outpatient total hip arthroplasty : a paradigm change. Bone Joint J 2018; 100-B:31.
Fillingham YA, Ramkumar DB, Jevsevar DS, et al. Tranexamic Acid Use in Total Joint Arthroplasty: The Clinical Practice Guidelines Endorsed by the American Association of Hip and Knee Surgeons, American Society of Regional Anesthesia and Pain Medicine, American Academy of Orthopaedic Surgeons, Hip Society, and Knee Society. The Journal of Arthroplasty. 2018;33(10):3065-3069. doi:10.1016/j.arth.2018.08.002
Gromov K, Jørgensen CC, Petersen PB, et al. Complications and readmissions following outpatient total hip and knee arthroplasty: a prospective 2-center study with matched controls. Acta Orthopaedica. 2019;90(3):281-285. doi:10.1080/17453674.2019.1577049.
Greenky, Max R. et al.Total Hip Arthroplasty and the Medicare Inpatient-Only List: An Analysis of Complications in Medicare-Aged Patients Undergoing Outpatient Surgery
The Journal of Arthroplasty, Volume 34, Issue 6, 1250 - 1254
Hartog YMD, Mathijssen NMC, Vehmeijer SBW. Total hip arthroplasty in an outpatient setting in 27 selected patients. Acta Orthopaedica. 2015;86(6):667-670. doi:10.3109/17453674.2015.1066211.
Lazic S, Boughton O, Kellett CF, Kader DF, Villet L, Rivière C. Day-case surgery for total hip and knee replacement. EFORT Open Reviews. 2018;3(4):130-135. doi:10.1302/2058-5241.3.170031
Parcells BW, Giacobbe D, Macknet D, et al. Total Joint Arthroplasty in a Stand-alone Ambulatory Surgical Center: Short-term Outcomes. Orthopedics. 2016;39(4):223-228. doi:10.3928/01477447-20160419-06. Vehmeijer SBW, Husted H, Kehlet H. Outpatient total hip and knee arthroplasty. Acta Orthopaedica. 2017;89(2):141-144. doi:10.1080/17453674.2017.1410958.
SBAR: TKA Outpatient Guidelines for Decision-Making. http://www.trinity-health.org/documents/clu/TKA_SBAR_and_References_Ortho.pdf.
Yates AJ, Kerr JM, Froimson MI, Valle CJD, Huddleston JI. The Unintended Impact of the Removal of Total Knee Arthroplasty From the Center for Medicare and Medicaid Services Inpatient-Only List. The Journal of Arthroplasty. 2018;33(12):3602-3606. doi:10.1016/j.arth.2018.09.043.
Comments