Same-day joint replacement surgery leading the way

watts-side.jpgQuestion: What costs more than $1 billion each year and requires about 594,000 days’ worth of hospital stays?

Answer: Hip and knee replacement surgeries.

More than 123,000 joint replacement surgeries took place in Canada in 2016 and 2017, at an average cost of $9,100 per surgery. Beyond the associated price tag, these inpatient surgeries come at a cost for patients, too: laying in a hospital bed, they’re more susceptible to infection and their return to everyday living is delayed.

Things are beginning to change. Helping lead the charge is MSH and its newly instated same-day joint replacement program. Using minimally invasive techniques, new modes of administering anaesthesia and a dedicated at-home recovery plan, the program will see patients return home within hours, not days, of having their knee or hip replacement procedures.

“We have aspirations to offer more surgeries to more people, although our biggest goal is to try to improve  the patient experience,” says Dr. Evan Watts, an orthopaedic surgeon who specializes in knee and hip replacement. He joined MSH in July, tasked with initiating the same-day surgery program. “In my opinion, people eat better, sleep better and they recover better at home. It also decreases the risks of complications associated with being in a hospital.”

We have aspirations to offer more surgeries to more people

When a surgery that previously required a hospital stay of two or three days becomes an outpatient surgery, some skepticism — Is it safe? Is this simply a cost-reducing measure? — is expected. But, Dr. Watts explains, the same-day model is simply an improvement upon previous methods, based on decades of research on operative techniques and pre- and postoperative care.

Surgeons at MSH are trained in muscle-sparing techniques that reduce the amount of trauma to muscle and issue, which helps aid patient recovery, especially early on in the postoperative period. Anaesthesiologists play a crucial role as well, meticulously planning the form and dosage of anaesthesia so that it offers an appropriate level of pain management without inducing high levels of nausea and immobility (often the cause of longer stays in hospital).

“Historically, if we look back at the early days, people were admitted the night before and they were staying for a week in hospital,” Dr. Watts says. “Really what we’ve done is perfected that process.”

Potential patients are fi rst seen at MSH’s Rapid Assessment Centre, where they receive a physician consultation within two weeks of getting a referral from their family doctor. Then comes an extensive assessment to establish whether they’re candidates for surgery, same-day or otherwise. Not every patient is eligible for same-day joint replacement; if an individual is elderly, has limited support at home and/or additional health issues, a postsurgical hospital stay may be required.

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Orthopaedic services
Hip and knee replacement surgery
Interprofessional Spine Assessment and Education Clinic (ISAEC)

Ahead of their surgery, patients participate in an education class, where they learn about the hospital, the procedure, pain management and physiotherapy: this is an opportunity for patients to have their concerns and questions addressed. They’re also equipped with a comprehensive take-home guide aboutboth the surgery and recovery. Once home, Dr. Watts checks in on the patient by phone. They also have access to an outpatient clinic, by phone or in-person visit, where a nurse practitioner can address any questions or concerns.


Throughout the process, from preoperative through to postoperative, patients will have a dedicated ally to help guide them through their experience at MSH. That person is Maria Caruso, a nurse and MSH’s orthopaedic patient navigator.

“My role is to give the patients the best possible experience through their surgical journey,” Maria says. “I become their support and a constant point of contact throughout their experience with us. It’s to ensure that they have a  seamless transition from the hospital back home once their surgery is done.”

In an overburdened healthcare system, where patients may often feel isolated,  Maria is a trusted confidante.

The first patient in MSH’s same-day joint replacement surgery program underwent a successful total knee replacement on November 5. The hospital, which typically performs about 800 total joint surgeries annually and has the second lowest surgical wait time for knee replacements in Ontario, expects that the same-day model will help  improve access for those needing surgeries and will enhance the overall experience.

“We’re providing the best patient care and putting patients in a setting where we know that they’ll be safe. We’re decreasing costs while still maintaining the safety of their care and most importantly, removing them from potential risk factors,” Maria says. “At the same time, the hospital is being more efficient…reducing wait times for patients.”

For Dr. Watts, knowing that sameday surgeries can help expedite wait times for other patients who may be struggling with chronic pain and limited mobility is especially rewarding.

“If we can decrease the costs associated with joint replacement, then we are able to off er more surgeries to more people within our community,” he says. “It’s fantastic.”

 

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