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Say good-bye to long hospital stays after knee, hip replacements
Innovations in joint replacement are leading to better patient outcomes
Modern orthopedic surgery features much technological innovation. Orthopedic surgeries at Northwell Health are no exception, with the latest state-of-the-art techniques driving superior knee and hip replacements. Northwell is pushing orthopedic surgery innovation in unexpected places with, new programs designed to improve patient care, and the patient experience.
Recovering at home. It sounds simple, but until recently, when you had a knee or hip replacement, going home the same day as your surgery was rarely an option.
“These types of procedures used to require a standard three to five-day stay in the hospital, followed by four to six weeks in a rehabilitation center,” says Jonathan Danoff, MD, Associate Medical Director at The Alvin & Dorthy Schwartz Ambulatory Surgery Center.
But Northwell health care experts started thinking differently. The shift began taking shape when Dr. Danoff created Northwell’s first ambulatory joint replacement program — an outpatient surgery center where patients recover at home — at the Schwartz Ambulatory Surgery Center. After seeing significant success, this program was subsequently launched at the free-standing ambulatory surgery center by Keith Reinhardt, MD, Chief of Joint Reconstruction at South Shore University Hospital.
“There was already overwhelming research that recovery at home and early mobilization enhances recovery,” says Dr. Reinhardt. “So the goal with our ASC was to create a boutique experience for these types of surgeries where home recovery was an option, a specialty center where the care is tailored to the patient from the time they arrive to the time they leave.”
“The people who get knee or hip replacement surgery are not sick, so why are we making them stay in the hospital?” Dr. Danoff asks. “Why not provide them the resources to recover at home?”
Michael Nett, MD, who works in orthopedic surgery, joint reconstruction and sports medicine at South Shore University Hospital, saw the benefits of home recovery immediately. “For many patients, recovering at home is the best option. You don’t need to be in a hospital to safely recover.”
Healing at home
Northwell’s “short-stay” or “23-hour” outpatient program—where ambulatory orthopedic surgeries are performed in a clinical setting rather than a hospital and patients are safely released within 23 hours of the procedure to recover at home—is the result of this sea change in how we think about surgery recovery. The program has been wildly successful. Dr. Reinhardt highlights that since the implementation of home recovery at the South Shore Surgery Center, no patients have been transferred to the hospital post-op or required readmittance for any complication.
Drs. Reinhardt, Nett and Danoff note that transitioning from a clinical recovery model to one more like the outpatient model used for ACL surgery took time and was facilitated by multiple factors, including patient interest and the pandemic. But, far and away, the first hurdle to jump to provide patients with the option to recover at home was reconsidering how to manage pain post-op.
“What we’ve realized is that a multi-modal approach to pain control is the key to avoiding long and now unnecessary hospital stays,” says Dr. Danoff. “I first started by standardizing the pain medication procedures post-op and then expanded preventive pain mitigation measures pre-surgery and during surgery.”
Patients who select the short-stay option for their joint replacement are comprehensively prepped to have a successful recovery at home, beginning pre-operation with a concierge-like patient-nurse consultation. Here, patients are told what to expect and how they should manage their care once they’re home.
As of now, the model has a 100 percent success rate at identifying who can go home and who needs to stay longer than 23 hours in the hospital. Dr. Nett notes that even those who require a hospital stay are staying for shorter and shorter periods.
More nerve blocks, fewer narcotics
Next, during surgery, the procedure is done using techniques that minimize blood loss and wound size. Anesthetics and nerve blockers are targeted at the site of the surgery to help reduce pain after the procedure.
Post-op, non-narcotic-based medications like anti-inflammatories are administered ― often at a patient’s home by a visiting nurse, a program pioneered by the program under Dr. Reinhardt ― as well as ice and prescribed movement. It’s not uncommon to see patients up and walking around 30 minutes to an hour after surgery, clothed and disconnected from their IV. The result is that patients are recovering faster and managing pain better while using 50 to 70% fewer narcotics. It’s a huge win for both patients and health care workers.
The whole experience has been reimagined to be more patient-friendly and to feel less like surgery.
“This is elective surgery — it shouldn’t be an ordeal,” says Dr. Danoff. “It should be the kind of thing you get done and then go out for dinner afterward. The type of thing where when someone asks you what you did today, you can reply, ‘I got my hip replaced,’ and it will not be a big deal.”
Northwell can confidently offer the recover-at-home option to select patients. Dr. Danoff has developed a research-driven predictive model to identify which patients could be eligible. These results are then used by a selection committee to determine a patient’s eligibility.
“While we use fairly extensive inclusion criteria, recovering at home is not just for people in their 40s and 50s,” says Dr. Reinhardt. “As we’ve refined our criteria, we have people in their 70s who’ve qualified and had fantastic results.”
Outpatient recovery model shows results
The overall effect has been game-changing, for both patients and health care systems. As patients recover at home, hospital resources are freed up for those who truly need them, which is always important but has been critical during COVID surges. Plus, patients who recover at home report higher psychological satisfaction and better overall physical outcomes.
This is the result of two important changes.
- First, the precision of ambulatory surgery has greatly increased. Northwell surgeons use state-of-the-art robotics that “map out” the patient’s ligaments and tendons in a computer program producing extremely precise results.
- Second, telehealth and at-home physical therapy have vastly improved. Patients now have 24/7 virtual access to their health care professionals. Virtual monitoring and PT apps have increased patient awareness of their own progress, producing results that are both faster and more physically comprehensive than traditional in-patient recovery.
“Ultimately, these programs are about giving patients more options while becoming more efficient as an integrated health care system,” says Dr. Danoff. “At-home recovery provides both.”
“And patients really love this option,” adds Dr. Nett.
If you’re looking into knee or hip replacement, choosing this innovative option might be right for you. Talk to your Northwell doctor about eligibility today.
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