Rapid Recovery in Total Joint Arthroplasty. Contemporary Strategies

Preface
Contents
Contributors
Chapter 1: The Changing World of Total Joint Arthroplasty
	Introduction
	Patient Selection
	Patient Education and Management
	Multidisciplinary Team Expertise
	Hospital and Ambulatory Surgery Centers
	Innovative Technology
	Supply Chain Management
	The Workforce Trends
	Summary
	References
Chapter 2: Understanding Alternative Payment Models
	Introduction
	Understanding the Common Alternative Payment Models (APMs)
		Bundled Payment Models: Bundled Payments for Care Improvement (BPCI) and Comprehensive Care for Joint Replacement (CJR)
		MACRA and QPP
		Private Insurance and Employer-Provider Contracts
		Cash-Pay Practice
	Keys to the Successful Implementation of APMs
	Current Evidence
	Conclusion
	References
Chapter 3: Insurance Contracting for Outpatient Arthroplasty Programs
	Introduction
	Vision and Strategy
	Defining the Bundle
		Patient Selection
		Episode of Care
		Standardization
	Potential Episode Partners
		Buildings
		Care Providers
		Payors
		Manufacturers
	Implementation
	Gainsharing
	Physician Champion
	Summary
	References
Chapter 4: Creating a Limited Stay Total Joint Program
	Introduction
	Patient Engagement Is Critical
	Shared Decision-Making and Modern Joint Camps
	Patient Selection and Appropriateness for Surgery
	Discharge Criteria and Home Care Monitoring
		Home Care Monitoring
		Transforming the Platform Into Efficiencies
	Outpatient Department: A Focused Factory for Improvement
	Dedicated Surgical Teams
		Results
		Conclusion
	References
Chapter 5: Preparing your Your ASC for Same-Day Joint Replacement
	Introduction
	Why the ASC?
	Patient and Case Selection
	Anesthesia
	Patient Flow
	Sterile Processing Department (SPD)
	Postoperative Care and Follow-Up
	Transfer Agreements and 23-Hour Observation
	Conclusion
	References
Chapter 6: Preparing Your Hospital for Same-Day Joints
	Introduction
	Why Are Same-Day Joints Performed at the Hospital?
	Culture Change
	Hospital Efficiencies
	Clear Protocols
	Mirroring the ASC Experience
	Conclusion
	References
Chapter 7: Patient Risk Assessment and Optimization
	Introduction
	Patient Selection and Risk Assessment
	Multidisciplinary Care Coordination
	Summary
	References
Chapter 8: Enhanced Recovery After Surgery (ERAS): The Changing Practice
	Preoperative Considerations
	Intraoperative Considerations
		Anesthetic Management
		Operative Management
	Postoperative Considerations
	References
Chapter 9: The Preoperative Clinical Pathway
	Introduction
	Patient Selection
		Modifiable Risk Factors
			Cardiovascular Disease
			Diabetes
			Obesity
			Malnutrition
			Staphylococcal Colonization
			Nicotine
			Narcotics
			Neurocognitive, Psychological, and Behavioral Problems
			HIV/AIDS and Viral Hepatitis
			Dentition
		Non-modifiable Risk Factors
			Age
			Chronic Disease
			Chronic Anticoagulation
			Antirheumatic Medications
	Preoperative Education
	Summary
	References
Chapter 10: Postoperative Clinical Pathways for Outpatient Arthroplasty of the Hip and Knee
	Introduction
	The Ideal Patient
	Anesthesia
		Regional Anesthesia
	Pain and Nausea Management with Perioperative Medication
		Pre-op
		Intra-op
		Post-op
	Blood and Fluid Management
	Physical Therapy
	Authors’ Preferred Protocols
	References
Chapter 11: Anesthesia Considerations
	Introduction
	Patient Selection and Preoperative Care
	Preoperative Analgesia
	Intraoperative Care
	Perioperative Considerations
	Antiemetic Care
	Postoperative Analgesia
	Regional and Local Blocks
	Mobility, Physical Therapy, and Teamwork
	Conclusion
	References
Chapter 12: Efficiency in Hip Surgery
	The Importance of Efficiency in Hip Surgery
	Outcomes Associated with Operative Time
	Preoperative Efficiency
		Patient Selection
		Patient Optimization
	Surgical Planning Strategies
		Preoperative Templating
		Preparing for “In-Flight Emergencies”
	Scheduling the Surgery
	Intraoperative Efficiency
		The Surgical Team
	Instrumentation
	Efficient Surgical Technique
		Pearls for Efficiency
			Patient Positioning and Table Options
			Specialized Retractors
			Hemostasis
			Internal Checks
	Closure Techniques
	Intraoperative Pain Control
	Postoperative Efficiency
	Technology and Efficiency
	Summary
	References
Chapter 13: Efficiency in Knee Surgery
	Introduction
	Tourniquet
	Approach
	Implant Considerations
	Computer-Assisted Surgery
	Patient-Specific Instrumentation
	Accelerometer-Based Navigation
	Preoperative Templating
	Template-Directed Instrumentation (TDI)
	Single-Use Instrumentation
	Closure
	Drains
	Urinary Catheters
	Conclusion
	References
Chapter 14: The Place for Innovative Technology
	Introduction
	Preoperative Period
	Intraoperative Period
	In-Hospital Postoperative Period
	Postoperative Period After Discharge
	Summary
	References
Chapter 15: Multimodal Pain Management Strategies in Total Joint Arthroplasty
	Introduction
	Preoperative Analgesia
		Acetaminophen
		Nonsteroidal Anti-inflammatory Drugs
		Gabapentinoids
		Glucocorticoids
	Intraoperative Anesthesia
		General Inhaled Anesthesia
		Total Intravenous Anesthesia
		Neuraxial Anesthesia
	Intraoperative Analgesia Adjuncts
		Peripheral Nerve Blocks
		Local Infiltration Analgesia
	Postoperative Analgesia
	Conclusion
	References
Chapter 16: Immediate Postoperative Rehabilitation
	Anesthesia Plan and Perioperative Outcome
	Postoperative Pain Management and Rehabilitation
	Perioperative Factors Affecting Immediate Rehabilitation
		Time of Admission and Rehabilitation
		Surgical Approaches
		Surgical Stress Response
		Blood Conservation
		Antimicrobial Prophylaxis
		Tourniquet and Drainage Influence
	Types of Prosthesis: Cemented Versus Non-cemented
		Mobilization
		Approach to Autoimmune Patients
		Wound Healing Adjuncts
	Physical Therapy Considerations
		“Prehab”
		Immediate Postoperative Rehabilitation
		Post-acute Care Rehabilitation
			THR
			TKR
	Care Coordination Considerations
		Health Agent Factors
		Patient and Family Factors
	References
Chapter 17: Achieving Milestones in Post-acute Rehabilitation
	Preoperative Rehabilitation
	Inpatient Postoperative Rehabilitation
	Discharge Planning and Post-discharge Rehabilitation
	Late Rehabilitation
	Rehab Milestones Following Joint Arthroplasty
		Day of Surgery/First 24 Hours
		Postoperative Days 0–3
		Weeks 1–6
		Weeks 7+
	Muscle Atrophy, Recovery, and Setbacks
	Future Directions
	Discharge Settings
	Standardization Needs
	Risk Stratification and Exercise Intensity
	References
Chapter 18: Skilled Nursing Facilities: It Is a Shared Partnership
	Introduction
	Trends in Discharge Disposition to SNF After TJA
	Discharge Destination and Effect on Outcomes, Complications, and Readmissions
	The Relationship Between SNFs and Cost Containment
	Predicting Discharge Disposition After Primary TJA
	Room for Improvement: The Time for Selective Partnerships Is Now
	Conclusion
	References
Chapter 19: Patient Surveillance in Total Joint Arthroplasty
	References
Chapter 20: Achieving Satisfaction with Patient-Reported Outcomes: PROMS
	Introduction
	Factors of Patient Satisfaction
	Current Patient-Reported Outcome Measures
	Evaluating Patient Satisfaction
	Predicting Patient Satisfaction
	Benefit of Patient-Reported Outcome Measures
	Integrating Patient-Reported Outcome Measures in Surgery Centers
	Interpreting Patient-Reported Outcome Measures
	Patient-Reported Outcomes Measures and Patient Satisfaction
	References
Chapter 21: Choosing Institutional Metrics
	Metrics to Evaluate Rapid Recovery Protocols
		Length of Stay
	Discharge Destination
	Mortality Rate
	Other Complication Rates
	Patient-Reported Outcomes
	Specific Functional Outcomes
	Well-Defined Functional Discharge Criteria
	Analgesic Drug Consumption
	Cost-Effectiveness
	HCAHPS Scores and Patient Satisfaction
	Comparing Outcomes to Standardized Baselines
	Author’s Recommendations
	References
Chapter 22: The Use of Evidence for Process Improvement
	Introduction
	Infection Prevention
	Minimizing Blood Loss
	Multimodal Anesthesia and Analgesia
	Functional Outcomes
	Conclusion
	References
Index