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Same Day Joint Surgery: What is It and Can I Have It

Dr. Brittany Boisvert with Emerson Orthopedic Associates discusses the benefits of same day joint surgery and who appropriate candidates are for the surgery.
Same Day Joint Surgery: What is It and Can I Have It
Featuring:
Brittany Boisvert, MD
Fun fact about Dr. Boisvert: During her fellowship in sports medicine at The Rothman Institute at Thomas Jefferson University Hospital, Dr. Boisvert was a staff physician for the Philadelphia Phillies, Philadelphia Eagles and other sports teams. 

Learn more about Brittany Boisvert, MD
Transcription:

Caitlin Whyte: When given the option to have an outpatient surgery, most patients would jump at the chance. But when it comes to same-day joint replacement surgery, you need to make sure you're a good candidate for the issues you're having. To tell us more about the process is Dr. Brittany Boisvert, a board-certified orthopedic surgeon with Emerson Orthopedic Associates.

This is Health Works Here. I'm your host, Caitlin Whyte. So doctor, what is same-day joint surgery?

Dr. Brittany Boisvert: So same-day joint surgery really is exactly as it sounds. It's folks who have typically knee or hip replacements and they come in that morning for their surgery and they're back home at their own house later that afternoon or evening.

Caitlin Whyte: And what are the benefits of this type of procedure?

Dr. Brittany Boisvert: So obviously one of the biggest benefits is that you don't have to spend a night in the hospital or two or three nights in the hospital as has been sort of the traditional hospital stay surrounding joint replacements in the last decade or so. Most folks will find that they are much more comfortable at their own home, in their surroundings without having to be awakened several times throughout the night to have their vital signs checked and waiting to get their pain medication. So there's a lot of benefits from that standpoint, just for the patient comfort level.

Also the benefit of not being in a place where there are people who are sick. When folks are having joint replacements, they're typically healthy people who really are just looking to get back to doing their activities and to keep them out of the places where folks are coming in with pneumonia and other types of infections before treatment can be really helpful to help minimize any complications they might have from the surgery.

Caitlin Whyte: So who would be a good candidate for this kind of surgery?

Dr. Brittany Boisvert: So some of the best candidates are folks who are on the younger side. And when we say younger side for joint replacement, it's typically people in their 50s, 60s, but we've even had folks in their 70s and approaching 80 who have done same-day joint surgery and it really just depends on the patient.

You know, we look for folks who obviously are already active and, you know, sort of robust. We certainly wouldn't want to send to someone who might be a little bit on the frail side back home without having a lot of help. So we look for folks who don't have a lot of medical comorbidities, certainly nobody with any significant cardiac or pulmonary history, where we would want to keep an eye on those people overnight after a big surgery like the joint replacement and with general anesthesia.

We also worry a little bit about folks who might be on their own. So that's another thing that we really talk about beforehand, is making sure that people understand what's involved, uh, with the same day surgery and with a joint replacement in general. We talked a lot about patients having someone at home as a support person who can help them to maneuver around the house. You know, if they live on the third floor, that's going to be very difficult to do in the same day of having a knee or a hip replacement.

So a lot of it has to do with what their home setup is like, um, like I said, having a support person available for a few days after the surgery and also their motivation. Some folks, the idea of going home the day of that surgery just doesn't appeal to them and certainly we don't want people to feel like we're pushing them home and we want it to be for the folks who just really feel comfortable being able to be back in their own surroundings.

So there's certainly a lot of things that goes into the selection of the folks that really are candidates for it being, like I said, on the healthier side and having that support system around them and being interested in it. It's not something that has to be done, but it's definitely the trend towards shorter hospital stays and getting people back into their homes.

Caitlin Whyte: So how is pain controlled afterwards?

Dr. Brittany Boisvert: So one of the biggest things that has come along that's allowed us to really make this transition is a medication called Exparel, which is essentially a long-acting numbing medicine. So it's something that we inject into the tissues at the time of the surgery. And so it really minimizes the amount of pain that patients will have when they wake up.

It also minimizes the amount of pain medication that the anesthesiologists need to give during the surgery. So when patients wake up from their surgery, they're really not as groggy as they might've been in the past where the anesthesiologists are giving them lots and lots of medications through their IVs and through gases.

So when they wake up, they have less pain. And that then really persists, it lasts for about 72 hours or so. So most of our patients at this point really aren't using anything for pain management other than Tylenol and sometimes some ibuprofen for the first few days. We typically do give, you know, still prescriptions for pain medications for those who need it, but it's really minimized the need for narcotic pain medications following the joint replacement by using this sort of adjunct to the pain management and anesthesiologists' regimens.

So it's really been sort of a game-changer in terms of allowing us to really get patients up and moving and walking around the same day of surgery with very little pain and seeing that they can do it and that they're safe to do it. So that then when it does wear off and they're uncomfortable, it's not as bad because it's been a few days since the surgery. But they also know that it's okay and that they can still do all of these things without having any problems.

Caitlin Whyte: Tell us about what research shows about the effectiveness of same-day joint surgery.

Dr. Brittany Boisvert: So it's relatively new. So there isn't a lot of necessarily robust research papers or studies about it. We'd certainly do know that keeping people out of the hospital and not using things like Foley catheters and other things like that really will help to minimize the risks of what are considered sort of hospital-acquired complications, so a hospital-acquired pneumonis, decreasing the rates of DVTs and PEs because people are being up and mobilized so that risk of blood clotting is really minimized after a joint surgery. And certainly the risk of an infection associated with a Foley catheter, urinary tract infection, obviously is going to go down since we're not even using them.

So it's definitely sort of in the early stages. So there's not necessarily a lot of significant, robust research about it at this point, but it certainly has been an ongoing process. And I think there will be a lot coming out in the near future that shows that patients have a much quicker recovery and return to activities with this approach.

Caitlin Whyte: So wrapping up here, what should patients know in order to decide if they should have this surgery?

Dr. Brittany Boisvert: I think a lot of it really depends as I mentioned a little bit on patient motivation. You know, like I said, for the folks who are interested in surgery, but not necessarily interested in having to spend time in the hospital or feeling like they're really losing a significant portion of time out of their life, this really is a great option.

And really, it's something to talk about with their family and with their support, you know, friends and people around them who might be able to help them out after the surgery. It can be a really excellent experience for the vast majority of patients that we see in the office who are ready to have their joint replacements and to get back to all their regular activities without that pain associated with arthritis, so that they can participate in family activities and not feel like they have to miss out on things because it's going to hurt.

So we're certainly happy to speak with anybody who has any questions about it, and really, it's open to almost anybody that wants to learn more about it. And like I said, we would have that conversation if it might not be the safest thing at this point. Certainly, our main goal is to keep everybody safe through the process.

Caitlin Whyte: Well, thank you so much, doctor, for sharing your time and this information with us. To find out more or to get in touch, you can call (978) 371-5390. That's (978) 371-5390. Or visit EmersonHospital.org/orthopedics. You can also visit her webpage page to see a video of a patient who had same-day joint surgery performed by Dr. Boisvert.

Thanks for listening to Emerson's Health Works Here podcast. Make sure to catch the next episode by subscribing to the Health Works Here podcast on Apple podcasts, Google podcasts, Spotify, or wherever podcasts could be heard. I'm your host, Caitlin Whyte. We will see you next time.