How to Choose an Outpatient Joint Replacement Surgery Center
This post was co-authored by Grace McClure and Dr. Nicholas Frisch, M.D., OS, MBA.
If you're leaning towards a same-day joint replacement surgery, chances are it’s because the idea of spending as little time as possible in the hospital is appealing. In addition, if you've been given the green light by your surgeon or care team to be an outpatient candidate, chances are you have a healthy body weight, you don't have any serious secondary conditions or diseases, and you have a support system who can aid in your recovery. Since your recovery happens at home, being healthy and prepared for surgery with a support system in place is 100% necessary to ensure the best outcome.
Here are 13 things you should know about same-day joint replacement surgery as you consider this option.
As you weigh the pros and cons of same-day surgery, it’s important to consider “the where”. Some patients may not have too many options when it comes to selecting an ambulatory center. Despite the growing popularity of outpatient joint surgery, it’s not offered in every town or even city across the US. However, for most patients living near urban centers who fit the health criteria, it’s a viable option. Choosing which outpatient center is best for you is an important step to take.
Read on and learn what to look for when evaluating a same-day surgery center for your hip or knee replacement.
What is the difference between outpatient and same-day surgery? Outpatient surgery and same-day surgery are one in the same. You will see these two terms used interchangeably. An outpatient surgery center is the same thing as an ambulatory surgery center. Both terms are used to describe where an outpatient (same-day) surgery takes place.
But first...here are some of the benefits of a same-day surgery:
- More advanced, cutting-edge care. Outpatient facilities are newer and tend to have forward-thinking surgeons that use the latest techniques.
- A lower cost option for patients and providers.
- Higher overall patient satisfaction. Outpatient joint replacement recipients report being more satisfied with the care they’ve received.
- Better surgery outcomes and recovery. Studies show that outpatient patients have fewer blood transfusions and infections and that patients can even recover faster at home.
- Shorter stay in hospital. A shorter stay in hospital lowers the risk of hospital-acquired infection and lets you recovery in the comfort of your own home.
How to Choose an Outpatient Joint Replacement Center
1. Does the Surgery Center Offer PreHab?
If you’re having an outpatient surgery, it’s absolutely imperative that you are prepared for surgery, setting yourself up for a faster, easier recovery. Being ready on surgery day means that you’ve mentally, physically and environmentally prepared for surgery in the weeks leading up to surgery. A well-rounded PreHab program, like PeerWell, will touch on all of these factors and deliver a daily checklist of exercises and lessons that will get you most prepared for surgery day.
A great outpatient/ambulatory center will focus on your preoperative health since they know that patients who are better prepared are lower risk and recover faster. An excellent outpatient center will not just host pre-op education classes for you and your post-op caregiver, but will offer a complete PreHab program to guide you for weeks leading up to surgery into recovery.
From a Physicians Perspective: "It is important to maintain close contact and schedule routine calls to ensure that there are no issues that require additional attention. An integral part of establishing a safe outpatient practice is to provide 24 hour access to our team and we spend a lot of time ensuring that there is always access when needed. Before deciding on a center you should make sure that they have the appropriate resources to be available in the event you should have a question or a concern come up."- Dr. Frisch
Getting prepared for surgery (PreHab) should include:
- Getting physically prepared (exercises that target the muscles that will support your new joint, that improve your pre-surgery range of motion etc.)
- Curbs unhealthy behaviors (like smoking or uncontrolled blood sugar) that put you at risk before surgery.
- Gets you mentally prepared for surgery (lowers anxiety about the procedure, teaches you drug-free methods to control pain etc.)
- Guides you through organizing your home to be a safe and comfortable place for your recovery.
- Helps you sort out all of the “extras” like packing for the hospital, getting your at-home caregiver ready, pre-ordering pre-cooking healthy frozen meals etc.
As a same-day surgery patient, you need to optimize yourself for surgery in order to hit-the-ground running in recovery. If you can do this, you will have a head-start on recovery and your new life.
2. Are You Comfortable with the Surgeon?
Like doing PreHab, another key thing you can do to ensure a successful surgery and recovery is to work with a surgeon that you trust. This means that if you prefer a surgeon at a traditional hospital, going with that surgeon over a less-skilled surgeon at an outpatient center may be a smart move. When choosing your surgeon, don’t focus on their bedside manner as much as measurable “baseball card stats” that paint a clearer picture. Since a replacement is a highly technical surgery, you want a surgeon who performs a high-volume of replacements, who has a proven track record, who has satisfied patients and so forth.
Here’s what to look for in your surgeon:
- He/she performs a lot of surgeries per year. In the US, an orthopedists average caseload for hip and knee replacement surgery is 384 per year. You want your surgeon to meet or exceed this volume.
- He/she has average or better complication rates. The complication rates associated with a surgeon are public knowledge. You can find this information on ProPublica under the “Surgeon Scorecard”. Enter in your surgeon’s name and you can see their complication rate and how many joint replacements they’ve performed. If you see a low number of cases and a high complication rate, look into another surgeon.
- He/she has satisfied patients. You can look up your surgeon’s patient reviews and ratings on WebMD or HealthGrades. Bare in mind that reviews tend to fall on the most extremes--very happy and very unsatisfied people tend to leave reviews. You can also ask your doctor to put you in touch with some of this past patients. This is relatively common, so your surgeon should be able to connect you with someone who has firsthand experience having a replacement with him/her.
Dr. Frisch adds that "Not all surgery centers are the same and it’s important to know that the center you choose is committed to achieving good surgical outcomes over simply being high volume. This isn’t always easy to identify, but one good indication is whether or not your surgeon or the center is providing you surveys on your functional outcomes before the procedure. Some surgery centers participate in State or National joint registries, which means that they actively report all outcomes to be compared with other hospitals and surgery centers."
3. Is the Surgery Center Accredited?
A center of excellence (COE) means that a hospital or care center is accredited for a specific specialty. When it comes to joint replacement surgery, there isn’t an official “center of excellence” designation like there is for other specialities like a “Center of Excellence in Metabolic and Bariatric Surgery (COEMBS)”. However, the Joint Commission does offer a certification to orthopedic care facilities who can measurably show things like: going above and beyond to deliver better patient care, having higher standards of surgical experience, practicing standardized surgical procedures etc.
The Joint Commission offers certification for joint replacement surgery and specifically, for Ambulatory Surgery Centers (ASC). The Ambulatory Surgery Center accreditation is reserved for same-day joint replacement centers that can:
- Demonstrate that they continuously assess and improve the quality of care, treatment, or services offered. This process includes a review by clinicians, including those knowledgeable in the type of care, treatment, or services provided at the organization.
- The organization provides services that can be evaluated using Joint Commission standards.
- The organization meets parameters for the minimum number of patients who have surgery
- And more. Click here for full eligibility criteria.
Find out if a facility you are considering is accredited. If so, they’ve clearly shown that they perform at a high-level.
From a physicians perspective: "Take a look at who is working at the enter. Is the surgery center anchored by a core group of surgeons or orthopaedic groups? If so, you can find out more about those groups by searching their websites or reviews online. This will also give you insight into the types of procedures performed there and if joint replacement is truly a specialty." - Dr. Frisch
4. Is the Surgery Center Part of a Good Hospital?
A lot of same-day joint replacement surgeries happen in special wings of a hospital. As such, you can look to how well the hospital checks out to determine if the outpatient center checks out too. Since outpatient surgery is less common, it’s a lot easier to research up on a hospital than it is an outpatient center. If the hospital has a good reputation, talented doctors and satisfied patients, the outpatient wing or affiliate center will likely follow suit.
If you’re considering an outpatient surgery at a credible hospital or hospital affiliate, research if the hospital:
- Is accredited by the Joint Commission.
- Has high patient satisfaction.
- Has high surgeon caseloads (perform above average number of replacements per year)
- Has average-low surgery complication rates.
- Has average-low hospital infection rates, and is rated well by U.S News Health Care Report and CareChex.
From a Physicians Perspective: "Have you meet with the surgery center team before surgery? This is something to consider. As part of preparation for surgery, many centers will actually have you come in to meet with the anesthesia staff and get a tour prior to your surgery. I think this is a great way to see the entire facility, better understand the process and feel comfortable with the entire process."
5. Is it Close to Your Home?
With a same-day surgery you will be discharged within 24 hours and sent straight home for your recovery. Since you will be transported home after surgery, you’ll need to live close to the ambulatory center. Although there isn’t a fixed maximum travel distance after surgery, you will need to consider your own comfort, safety and pain levels. You don’t want to over do it by spending a couple of hours in the car to drive home after an invasive procedure.
As such, unlike an inpatient joint replacement procedure that can be done at most local hospitals, an outpatient surgery is geographically permitting. If you don’t live in a town or city that has an outpatient joint replacement center (or one within a reasonable driving distance), it’s simply not an option for your upcoming hip or knee surgery.
Thinking about a hip or knee replacement? Set yourself up for success by getting matched with a top orthopedic surgeon in your area who offers PreHab for free. PreHab preps you for joint replacement surgery--whether it's inpatient or outpatient.
Dr. Nicholas Frisch, M.D., OS, MBA is an award-winning orthopedic surgeon based out of Rochester, Michigan. He focuses on minimally invasive joint replacement surgery and complex revisions. Dr. Frisch completed his residency at Henry Ford Hospital in Detroit and his Adult Reconstruction Fellowship at Rush University Medical Center in Chicago. Dr. Frisch is has won Orthopedics Best Clinical Article Award, the AAHKS Healthcare Policy Fellowship, Outstanding Resident Award Henry Ford Hospital, the Ford Motor Co. Connected Health Challenge, and more.