Fast-track surgeries in orthopedics are more important now than ever with health systems looking to get patients up and moving quicker with less time spent in this hospital while also reducing costs.
Fast-track surgeries have the potential to get patients safely out of bed, drinking and eating faster.
Even complex surgeries like total joint replacement are being fast-tracked, and the anesthesia used during surgery plays an important role in how quickly a patient can get back on their feet post-surgery.
At his institution, Emory Healthcare, orthopedic surgeon Thomas L. Bradbury, M.D. says that one of the most important factors in a successful fast track joint arthroplasty surgery is patient preparation and engagement.
“Being able to walk four hours after total hip replacement is not so much about surgical technique or the type of implant used. I think we can all agree that the preoperative ambulatory experience is more important than what happens the day of surgery,” Bradbury said.
Patient Engagement
“Patient selection and their education on what to expect are key and then you can drive engagement in the process, and with that you are rewarded with patient safety and satisfaction which can occur in a short interval after surgery,” he said.
He added, “I think the single most important variable you can control when it comes to the length of stay is what you tell them. If you tell them there is a high chance they will go home the same day, as long as you are safely mobilized and are comfortable enough, there is a high chance your patient will be up and around that day if not the following day and I think that is very important.”
Bradbury explained that there are a lot of details that that go into getting a patient out of the hospital in one day.
He gave an example of the first patient of the day:
“It’s 6 am. He or she spends 30 minutes doing paperwork, 30 minutes getting ready and then back to preoperative holding. Then after their preoperative anesthesia evaluation, they are typically ready for surgery by 7:15 a.m.”
Most of primary arthroplasty cases are completed in an hour or less and then the patient spends 30 minutes to an hour in PACU (Post-Anesthesia Care Unit) before going to the floor. At that point the patient has four hours to demonstrate that he or she is safely mobilized and comfortable enough to go home in the afternoon.
Bradbury said that for all this to get done in such a short interval, team consistency is crucial. And the type of anesthesia the anesthesiologist uses is an integral part of that.
