Surgeons push back on same-day knee replacements

Opponents say this is not appropriate for up to 45,000 of the annual surgeries and that caution needs to be exercised to ensure patients’ best interests have precedence over the drive to save money.

‘“The model beginning to be adopted in Australia, where private patients are having surgery in health fund-owned hospitals that make deals with doctors who work in their hospitals is clouded by vested interests” said Dr Michael Solomon, president of the Australian Arthroplasty Society. Arthroplasty is the surgical reconstruction or replacement of a joint.

Replacement quality

Over the past 12 years, the length of stay for both hip and knee replacements has reduced from more than seven days to four.

“It is important that any further reduction in stay does not compromise the quality of joint replacement,” says another panellist, Professor Richard de Steiger, deputy director of the Australian Orthopaedic Association National Joint Replacement Registry.

Post-operative care is distinct from rehabilitation, although the two can overlap.

During the webinar entitled “Short Stay Arthroplasty – the Australian experience”, it was argued that short-term day surgery could be appropriate for 60 to 70 per cent of patients.

For the others, who were typically older and frailer, with more complex medical conditions, it was important for the sustainability of Australia’s health system not to push them out too early.

The panellists were unanimous in their support for shorter stays, followed by rehabilitation, and highlighted that this was only one factor in a whole of system approach that needed to put the patient first.

Most cost savings can occur without rushing patients out of hospital too early, said Professor Christopher Vertullo, president of the Australian Knee Society.

“As over 90 per cent of patients do not require expensive inpatient rehabilitation after joint replacement, orthopaedic surgeons must ask their patients to re-think inpatient rehabilitation”.

Dr David Liu, scientific secretary of Australian Orthopaedic Association Queensland and an editorial board member of Knee Surgery and Related Research, said there was a role for digital technology in rehabilitation.

He said innovation that focused on the patient, including smartphone apps that guided them through pre- and post-rehabilitation plans, which surgeons could monitor, could provide real benefits.

Dr David Mitchell, director of orthopaedic surgery at Ballarat Base Hospital and a proponent of ‘‘Rapid Recovery Surgery’’, said that when it came to post-operative care, it was important to ensure everyone involved in a particular patient’s care was on the same page.

“Staying longer in hospital after arthroplasty is proven to be associated with worse outcomes for the patient. Equally, in-patient rehab is wrongly perceived to have better outcomes.”