Caitlin Whyte (Host): This is WakeMed Voices. I'm your host, Kaitlyn White. And with me is Dr. Lincoln Pratt, an orthopedic surgeon with Wake Orthopedics, Join us as we talk about outpatient joint replacement. Doctor. To begin, can you tell us what inspired you to specialize in joint replacement?

Dr. Lincoln Pratson: Yeah, I actually grew up with a background in construction. And then, as part of my educational career, fell in love with athletic training orthopedics ended up being the path that combined that the most, where I got to take a lot of the principles that I loved in terms of the construction and building things, And then apply it to, uh, area of the human body and medicine.

I was extremely interested, which was the musculoskeletal system. As I've focused in it more, I've really just been impressed about how joint replacements are to allow active people to get back to the activity level that they want to. and I just really, enjoy working in this space and, and helping people this way.

Caitlin Whyte (Host): Now, what exactly qualifies a joint replacement as outpatient, and how does it differ from that traditional inpatient surgery?

Dr. Lincoln Pratson: Joint replacement typically refers to having a knee or hip replacement and discharging within the same calendar day. Traditionally, after a knee or hip replacement, patient's would stay in the hospital for several days or even longer. And the key difference not only lies with the timing of the discharge, but just actually the entire care pathway, in which case the outpatient procedures require more intensive, preoperative screening, patient education, multimodal pain regimens, and a strong social support that allows them to discharge the same-day.

Caitlin Whyte (Host): And which patient's are typically good candidates for outpatient hip or knee replacements?

Dr. Lincoln Pratson: the ideal candidates are typically healthy, often younger, 75 years old or less, and without medical comorbidities, that would require monitoring in the hospital postoperatively. They should also have good social support at home during those first couple postoperative days. And typically we reserve outpatient surgery for patient's undergoing primary, hip or knee replacements, meaning that, we're replacing the hip or the knee for the first-time.

We do know that as we've been doing more of these outpatient, hip or knee replacements, people are doing well and we're actually expanding the, criteria associated with it such that we're finding that it's safer for older patient's or patient's with more medical conditions to discharge home the same-day.

Caitlin Whyte (Host): Well walk us through that patient experience. What does the day of surgery look like when someone is going home later that same-day?

Dr. Lincoln Pratson: Yeah, so the beginning of the day looks the same. Typically, whether you're presenting to go home the same-day or you're planning on staying in the hospital, you arrive at the hospital a couple hours before your surgery, get seen by the surgeon, as well as the anesthesiologist and get teed up for surgery.

After the surgery is performed safely, you'll wake up in the recovery unit and at that point the therapist will come work with you and make sure that you feel comfortable walking, going up and down stairs, and, participating in the activities of daily living that you need to in order to discharge home safely.

Have the case manager come and work with you and make sure that you have everything that you need and make sure you have your medications to come home with too. Typically you spend between six to eight hours in the hospital from the time you arrive to the time you discharge.

And then after meeting the discharge criteria, including your pains controlled, you've checked off those, check marks like walking, going up and down stairs, doing what you need to do. You're then discharged home with detailed instructions and close follow-up, as well as the ability to contact the surgeon and their team should any questions or concerns arise.

Caitlin Whyte (Host): And what new surgical techniques or innovations have made outpatient joint replacement safer and more accessible now?

Dr. Lincoln Pratson: so addressing the postoperative pain through multiple different pathways, has represented the most significant advancement, And that, includes combining a number of different medications, trying to avoid narcotics as much as possible, and, attack that pain through different modalities. And then also working with the anesthesiologist from a regional anesthesia standpoint, which will put local medication into the wounds or blocks and try to minimize the pain that people are having after surgery as much as possible.

And then we actually have looked in the past about why patient's were unable to discharge after surgery. And a lot of times it wasn't related to the pain themselves, but the complications that patient's would have from anesthesia, whether it was that they got too many fluids and they had a hard time, with urinary retention after surgery.

Or they had too much anesthesia and they were groggy and therefore drowsy and not able to work with therapy. After surgery, we've gone back and worked closely with our anesthesia colleagues, the nurses, the therapists, in order to address those common reasons why patient's weren't able to discharge in the past.

I.

Caitlin Whyte (Host): And from your perspective, what are the biggest benefits for patient's choosing this one day outpatient joint replacement?

Dr. Lincoln Pratson: The short answer to the question is that it's safer. And so patient's who have a hip or knee replacement and go home. The same-day are at a much lower risk of having a complication, after surgery, even needing to show backup in the hospital after surgery than those who stay in the hospital after surgery.

that risk is decreased, about a third for patient's undergoing a hip replacement and about 15% for those undergoing knee replacements. It also benefits that people are able to recover at home. I think the hospital's a good place to be if you need to be there, but sometimes it's not the best place to recover.

There's lots of people around you. You need to get your vitals checked. It's a hard place to get sleep afterwards, and oftentimes people feel more comfortable recovering in their own environment, And so there's I think a faster rehabilitation and improved patient satisfaction when you're recovering at home. Finally, a decreased cost and insurance companies are beginning to pass along those savings to the patient's in form of lower copays if they're undergoing surgery at an outpatient procedure.

Caitlin Whyte (Host): And are there any misconceptions that you hear from people about having this outpatient joint replacement?

Dr. Lincoln Pratson: Yeah, I think the biggest misconception is the focus on age. I think what we know is that age is a number and. really what we should be basing this off of is the patient's activity level as well as their, you know, the other medical conditions that they have. And so we work very closely with their primary care doctor, any other specialist, to make sure that a, it's safe, that they undergo a hip or knee replacement at the beginning, And then.

And then what the safest way to discharge afterwards is whether it's staying in the hospital for a day or two or going home the same-day. And I think the main thing is, I, myself And the rest of the team only want what's safest to the patient. What we do know is that sometimes it is safest for patient's to go home the same-day and sometimes the safest for them to need to stay in the hospital.

And we'll work with each patient specifically to make sure that we come up with the right care plan for them.

Caitlin Whyte (Host): And looking ahead, doctor, how do you see outpatient joint care evolving in the next few years?

Dr. Lincoln Pratson: outpatient hip and knee replacement is already becoming the standard of care, especially when you look at kind of how Medicare is, viewing these procedures. And I expect it to only increase in which the eligibility criteria, the patient's that we deem appropriate for outpatient surgery. Only becomes wider and wider, and more and more patient's can expect to go home after surgery.

I think it's important to realize that because it really does take a multi, multi-team approach in which you're working with not only the surgeon, the anesthesiologists, the therapists, the nurses, the case managers, and we've done a lot of work at Wake Med in order to make sure that that's the case And that the patient's are supported and ultimately to the safest outcome.

Caitlin Whyte (Host): you so much for joining us, Dr. That was Dr. Lincoln Pratt. To learn more about Wake Orthopedic Services, please visit wake ortho.com. If you enjoyed this podcast, please share it on your social channels and check out the entire podcast library. For topics of interest to you, I'm your host, Kaitlyn White, and This is Wake Med Voices brought to you by Wake Med Health and Hospitals in Raleigh, North Carolina.

Thanks for listening.