and fears of a second wave have created an uncertain future, Dr. Shah
believes the pandemic and its aftermath could accelerate the growth
of same-day joint replacements as surgeons, patients and payers real-
ize it's best to spend as little time as possible in healthcare facilities.
"The COVID-19 crisis should provide a push for what was already
happening across the country," agrees Steven B. Haas, MD, chief of
the knee service at the Hospital for Special Surgery (HSS) in New
York City. "The number of cases outpatient facilities take on will
only increase."
Facilities that want to capitalize on the expected influx of cases by
adding a same-day total joints program or expanding the number of
procedures they're already performing should focus on the following
elements to build programs set up for long-term success.
• Appropriate candidates. The most important component of a
successful same-day joint replacement program is patient selection,
according to Dr. Shah. The right candidates often emerge by identi-
fying patients with comorbidities — such as obesity, smoking and
diabetes with an A1C greater than 7% — who are unsuitable to safe-
ly undergo outpatient procedures.
Selecting candidates for surgery should also involve assessing a
patient's physiological status and social support structure to ensure
they have the mental fortitude and help they need to recover at
home.
Dr. Haas is also a big proponent of putting patients on comprehen-
sive prehab programs and optimizing their pre-op nutritional status to
prepare their bodies for the trauma of major surgery and improve
their abilities to recover quickly.
"Prehab is important because the better condition patients are in
heading into surgery, the better condition they'll be in coming out," he
says.
4 2 • O U T P A T I E N T S U R G E R Y M A G A Z I N E • J U L Y 2 0 2 0