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Shouldn't You Be Doing Outpatient Total Joints?
Our special pre-conference session will show you that same-day total joint surgery is now within your reach.
Christopher McClellan, David Berkheimer
Publish Date: May 22, 2014
OR Excellence
Chris McClellan, DO Chris McClellan, DO
David Berkheimer, CRNA David Berkheimer, CRNA

Speaker Profile

  • Performed nearly 100 joint replacements since launching same-day total joint program at their surgery center 2 years ago.
  • Register now for their 2-day pre-conference session at OR Excellence.
  • Seating is limited to the first 50 registrants.

Close to a million patients in the U.S. undergo knee or hip replacement each year, and virtually all of them spend 2 to 3 days in the hospital recovering. But a revolution is underway. That's what Chris McClellan, DO, and David Berkheimer, CRNA, think, anyway. Dr. McClellan, a high-volume joint surgeon, and Mr. Berkheimer, a crack regional anesthesia specialist, have pioneered a highly successful outpatient total joint program in their ambulatory surgery center. Whether you work in an inpatient or outpatient facility, they are more than happy to show you how they did it. Just sign up for their Same-Day Joint Workshop at OR Excellence, Oct. 14-15, at the New Orleans Marriott. We caught up with them after a hard day of knees and hips in Altoona, Pa.

  • Why not keep patients under observation overnight in a hospital setting? Ten or 15 years ago, when total joint surgery was very invasive, pain control was primitive and the patient was immobile for days, admitting these patients was necessary. But a lot has changed since then. Modern surgeons who use minimally invasive approaches for knee and hip surgery can do a knee in less than 40 minutes and patients lose less than 100cc of blood. Meanwhile, continuous nerve blocks provide outstanding pain control. We don't need opioids, so side effects like PONV, ileus, respiratory depression or pruritis are non-issues. Plus, home recovery patients avoid all the risks of a hospital stay, like medication errors and nosocomial infections. Patients are also more comfortable, they sleep better, and they rehab better.
  • The results so far. A look back at our first 100 patients indicates that this approach produces better results than the inpatient approach. Thanks to the terrific pain control provided by our anesthesia team, these patients never experience breakthrough pain and never have to visit the ER. Our DVT incidence is very low — 1 incident in 100 cases — probably because our patients are so active post-op and our PT is so aggressive. We've had 1 fall, requiring re-suture of the wound. And we've had 1 superficial infection, which cleared with a little antibiotic coverage. We've had zero readmissions.
  • The most difficult aspect of doing same-day total joints. At this point in our program, the biggest challenge is physically getting the patient back in his house. Patients feel so good after the procedure we've actually heard some stop at Dairy Queen on the way home. Once they get to the house, though, if there's a significant number of steps, we have to deal with it. We have the home nurse and the PT specialist meet the patient in the driveway to help get him in the house, assessed and tucked in.
  • Your biggest worry. A fall. A home nurse visits the patient's house at least 10 days before the procedure to remove everything that could be a fall hazard. During the post-op period, the patient gets 10 visits from the PT specialist and 10 to 12 from the home nurse. We're committed to make them safer at home than they would be at a hospital.
  • The financial implications to outpatient TJR. About a million total joints are done every year, so outpatient TJR opens up a significant potential market for ambulatory surgery centers. For hospitals, doing a case outpatient requires them to forfeit the income associated with inpatient care, but they will adapt, just as they did with cataracts and gallbladders. The demand for TJR in this country is going to triple because of demographics. There also may be a market in medical tourism. In some countries total joints require a 5- to 7-day hospital stay. A lot of international patients are ready to pay to avoid that. We've seen that insurers and self-insured employers are extremely interested in this. We calculate that we've already saved our patients and their employers between $2 and $4 million, and we're just getting started.

    For patients and insurers, the implications are huge. Outpatient total knees cost between $13,000 and $15,000, about a third of what they cost in the hospital. For patients, that means their co-pay is one third of what it would have been. Surgeons and anesthesia providers don't receive any extra compensation, but they may attract more cases, since so many patients would rather recover at home than in a hospital. We've drawn patients from as far as 2 hours away.

Special 2-Day Total Joint Replacement Workshop at ORX

hip replacement HIP REPLACEMENT Dr. McClellan removes the old hip socket during a 40-minute total hip arthroplasty.

You won't want to miss the Same-Day Total Joint Workshop, our special pre-conference session at this year's OR Excellence. Hosted by orthopedic surgeon Christopher McClellan, DO, and Dave Berkheimer, BSN, CRNA, who perform same-day total joint surgery at Advanced Center for Surgery in Altoona, Pa., the hands-on total joint workshop will take place over 2 days:

  • Tuesday, Oct. 14 from 1 p.m. to 5:15 p.m.
  • Wednesday, Oct. 15 from 7:30 a.m. to 11:30 a.m.

You'll then have 90 minutes to freshen up and check in with family and work before OR Excellence begins 1 p.m. Wednesday.

Seating for the 8-hour workshop is limited to the first 50 attendees. Cost is $239 per person. Register at orexcellence.com.