Pain management is also important during all three stages of surgery. Preoperatively at his institution, Edwards said they administer:
- Celebrex 400 mg PO
- Oxycontin CR 10 mg PO
- Toradol 15 mg
During the operation, pain management includes a general anesthetic and peri-articular local anesthetics. Patients also receive 1g tranexamic acid given IV or topically. No folly catheters are used.
After the surgery, patients receive only oral pain medication either Hydrocodone 5 mg (for the narcotic naïve) or Oxycodone 7.5 mg (for patients who have taken narcotics preoperatively).
Physical therapy starts within approximately three hours after the patient arrives on the floor POD#0 and beginning early around 7:30 a.m. on POD#1 with all patients discharged by 11 a.m. on POD#1 and 94% of their patients discharge to home.
Their discharge criteria includes:
- Ability to walk 80 feet on level ground
- Ability to walk up and downstairs
- Ability to transfer in and out of car
- Ability to stand from bed
- Ability to transfer back and forth from the bathroom
- Ability to dress self
- Pain, nausea/vomiting under control
- Ability to void
- Vital signs stable
- Have a ride home and support set up at home during recovery
Edwards said they also provide a hotline number in patients’ pre-op packets for when they have an emergency during the middle of the night and on weekends. They also have it set up so a third party, in their case TAVHealth, follow ups with patients at a minimum at 48 hours postop, 10 days postop, 4 weeks postop and 3 months postop.
Edwards and colleagues have conducted several studies to measure the effectiveness of their clinical pathway. In “Avoiding Readmissions – Support Systems Required After Discharge to Continue Rapid Recovery?” published in the April 2015 issue of the Journal of Arthroplasty, they retrospectively reviewed 1,874 total joint arthroplasties, finding that the use of a patient management support system like TAVHealth in their clinical pathway helped reduce the readmission rate.
However in “A Perioperative Patient Support System Was Unable to Mitigate the risk of Hospital Readmission for Total Hip Arthroplasty Patients With High American Society of Anesthesiologist Grades” published in the April 2017 issue of the Journal of Arthroplasty, Edwards and colleagues found that high ASA (American Society of Anesthesiologist) grade predicted increased readmission for THA regardless of the clinical pathway.
