For qualified candidates, Total Knee Arthroplasty (TKA) performed as an out patient procedure in either an ambulatory surgery center or a hospital offers appealing benefits. Traditional TKA performed as an in-patient procedure at the hospital can require a hospital stay of one to three days, and for some, followed by a transfer to a sub-acute rehabilitation center for another one to two weeks. In contrast, the same TKA performed as an out-patient procedure allows the patient to be discharged the same day to recover post-operatively in the comfort of their own home and realize a significant decrease in cost.
Cost savings are maximized when the procedure is performed in an ambulatory surgery center. These savings are realized not only with the elimination of hospital and rehab facility in-patient expense, but facility charges for operating room and recovery time at an outpatient surgery cetner are less expensive than a hospital with the added benefit of reduced risk of acquired infection.
Additional attention and patient education is required in determining a patient’s eligibility as a candidate for TKA in an out-patient surgery center. The relative physical health, mental understanding of and commitment to assuming responsibility for physical therapy post-operatively, and the presence of a caregiver at home during the first 48 to 72 hours to assist the patient with daily living activities are initial requirements. In addition, careful insurance coverage review is applied to secure pre-approval from payers. Not all insurance providers will pay for the outpatient procedure.
Potential patient candidates are assigned a “total joint coordinator” who facilitates that the necessary resources are in place to provide the patient with care from pre-operative to post-operative recovery. This care begins with a visit to a physical therapist for a full evaluation, gait training, and instruction of home exercises prior to surgery day. Within a few hours after surgery, the therapist also works to help the patient begin walking before being discharged to home. Once home, the patient receives visits from a home health care worker to provide care for the surgical site beginning 48 hours after surgery for two weeks, and begins physical therapy either in-home or as an out patient.