By GREGORY ZELLER //
A need for speed – and revolutionary, multidisciplinary approaches to pre-op education and post-op recovery – have Northwell Health kicking joint-replacement patients to the curb.
Relax, it’s all good: The staff at the Manhasset-based North Shore University Hospital is indeed discharging certain joint-replacement surgical patients on the same day as their operations, but it’s part of a groundbreaking protocol designed to promote ambulatory procedures.
That’s better for everyone involved, starting with the patient, according to Nick Sgaglione, Northwell Health’s chairman of orthopedic surgery, who notes joint-replacement patients who qualify for outpatient protocols – more on that in a moment – receive “the highest quality orthopedic surgery” and “the comfort and familiarity of being home with family to recover.”
Building on what Northwell Health calls “proven outcomes” from its Orthopaedic Institute and the NSUH Orthopedic Department, the same-day joint-replacement programs include “extensive preoperative education” and “rapid recovery protocols,” as well as “close communication with the multidisciplinary team” working each patient’s case.
Because there are more risk factors involved, not every joint-replacement surgical patient qualifies as a “short-stay patient.” Sgaglione referenced a strict range of physical and environmental requirements before a patient can take the in-and-out path.
“To have the best outcomes for same-day total joint-replacement surgery, candidates for the procedure must be carefully selected,” the doctor said. “Patients are evaluated for several possible risk factors – associated medical issues, generalized health and fitness and how robust support is at home.”
Despite those limiting factors, Northwell Health has already found enough qualifiers to begin expanding its same-day joint-replacement options. The first total hip replacement was done at NSUH’s Albert & Dorothy Schwartz Ambulatory Center on Feb. 11, following a number of outpatient total shoulder replacements performed in 2018.
To facilitate the same-day hip replacement, surgeons utilized a “direct anterior” approach, referring to the surgery being executed from the front of the hip – less invasive than traditional surgical techniques, according to Northwell Health, which notes less muscle-tissue dissection.
The anterior approach also puts patients at lower risk for subsequent hip dislocations and “promotes faster recovery than conventional hip-replacement surgery,” the New Hyde Park-based health system added.
Advances in pharmaceutical pain-management – specifically, increased use of “anesthetic blocks,” which involve short-term injections to block local nerve bundles – add another critical component to the home-recovery program, according to Sgaglione.
“We are better able to optimally treat pain with select anesthetic blocks,” the doctor noted. “After surgery, we have more effective alternatives to opioids for pain management and less side effects.”
With the in-and-out hip-replacement protocols now in effect, the Schwartz Ambulatory Center is already working to add new outpatient joint-replacement options to its Same Day Joint Program, including knee-replacement surgeries.