You've performed close to 10,000 outpatient joint replacements over the last 15 years. What have you learned?
Everyone thought it couldn't be done. First, I've learned that it's possible. I've also realized that the large majority of patients — from young to old, healthy to sick — can be done in the outpatient setting. There are very few reasons to keep them overnight.

Did you get pushback when you first started?
People used to think I forced my patients out of the hospital. That simply wasn't true. Patients continue to love the convenience of same-day discharge. Rush University Medical Center is a wonderful hospital. If patients are sick and dying, it's the place for them to be. But if they're recovering from joint replacement procedures, they should do it at home.

What's the oldest joint replacement patient you've operated on in an outpatient setting?
A 92-year-old man who had his knee replaced.

Wow. And he did OK?
He did great. There's a lot of talk about the suitable age for outpatient joint replacement, but that's not the determining factor. I've operated on patients in their 80s who were spry and healthy, and ready to go home after surgery. I've also operated on 50-year-olds who were out of breath getting up on the exam table. They weren't fit for a haircut.

Can surgery centers and hospitals that both offer outpatient joints coexist in the same community?
I think so. Surgery centers will inevitably cannibalize some patients from hospitals, but I don't think it's a zero-sum game. There are lots of patients who need joints replaced, but aren't getting them done for a variety of reasons. As we make the operations easier and more convenient — and less of a big deal — we'll get more patients into the system. Hospitals will lose some patients, but their overall business will grow.

So hospitals can compete?
Well, there's no way they'll ever beat the small overhead and nimbleness of surgery centers. Rush is planning to build an ASC primarily for hosting joint replacement procedures. I think you'll see more hospitals doing the same, so they can come closer to leveling the playing field with freestanding facilities. OSM