Which Patients Can Be Discharged the Same Day as Surgery?
Dr. Stefan Kreuzer answers ICJR’s questions about the steps he and his staff take to ensure patients can safely return home the same day as their joint replacement procedure.
ICJR: What are your discharge criteria for same-day discharge after joint replacement surgery? What must your patients be able to do before you’ll release them?
Stefan W. Kreuzer, MD: We are currently only discharging partial knee replacement patients the same day as surgery, following strict criteria for discharge in 4 areas: pain level, ability to void, wound drainage, and ability to ambulate. These are the specific criteria:
- Pain. The patient’s pain must be adequately controlled – 3 or less on a scale of 1 to 10 – on oral medications.
- Ability to void. The patient must void at least 200 mL after the indwelling urinary catheter has been discontinued. If the patient cannot void or voids substantially less than 200 mL, we do a bladder scan. We use a straight catheter to drain the bladder if the scan shows more than 250 mL of retained urine.
- Wound drainage. We place drains in the wound during surgery. They’re removed and the patient can be discharged if postoperative wound drainage has been 150 mL or less. The patient is discharged with a bulky dressing for continued compression and support. The dressing is removed in 2 or 3 days during the first follow-up office visit, and we then give the patient 2 surgical dressings to use at home.
- Ability to ambulate. The patient must be able to safely ambulate with crutches or walker before dischargeAmbulation is evaluated by a physical therapist or nurse, who also provides gait training.
ICJR: What type of support system needs to be in place for patients to go home the same day as surgery?
Dr. Kreuzer: The most critical part is preoperative education; it’s the most important factor in same-day discharge.
A “coach,” who could be a family member or friend, is asked to attend the education class with the patient so he or she is able to offer reinforcement during the postoperative period. We also help the patient prepare for being at home after surgery, including acquiring the equipment that will be needed and planning for transportation to the clinic in 2 or 3 days for a postoperative wound check.
We call the patient the day after surgery to find out how they’re doing at home, which gives us the opportunity to answer any questions and address any concerns that may have come up.
About the Expert
Stefan W. Kreuzer, MD, is from Inov8 Orthopedics, Houston, Texas. He is fellowship-trained in adult joint reconstruction.
Dr. Kreuzer has disclosed the following: intellectual property rights/royalties from Stryker Orthopaedics; speaking engagements/speakers bureaus/presentations with Brainlab, Inc., and Medtronic, Inc.; consulting for Carin USA, Pacira Pharmaceuticals Inc., and Smith & Nephew; sponsored travel for Brainlab, Inc., and Pacira Pharmaceuticals, Inc.; board membership/other fiduciary duties with ISTA, Memorial Bone & Joint Research Foundation, and Surgical Care Affiliates; ownership in Innovative Orthopedic Technologies, Argentum Medical (Silverlon), and OrthoSensor.