Outpatient Surgery

[GottaDoIt]

I'm scheduled for LTKR this August 2017 in an Outpatient Surgery Center and I am a little anxious about going home the same day. The surgery center is well-known in the community for their successful operations; however, TKR surgeries were just added last November 2016. I understand the concept, e.g., less likely to get an infection, get the knee moving quickly, PT education before surgery, etc., but the idea still creeps me out a little. Does anyone have some advice how to calm the nerves? Thanks in advance.

 

[jaschembra]

I definitely don't have any educated information but have heard this is being done more out there.
My #1 question would be the pain relief protocols - during surgery and post op.
If you are comfortable with your OS and this is where he successfully performs his many many TKR's then this should help calm you.
My surgery was at 9:30 a.m. on a Tues. and I was released at 4:30 p.m. on Wednesday. I needed stronger meds about 10 hours later when all their IV stuff wore off.

 

[Jaycey]

@GottaDoIt is out patient the only option? What if you aren't ready to go home - do they have plan B? I can certainly understand your concern. That first 24 hours post op can be tricky. Getting your pain management cocktail just right is your #1 priority.

Can you discuss this with your surgeon? It might ease your fears if you know what to expect.

 

[dmetz]

I'm having outpatient RTKR on June 5, 2017. I'm really excited to be able to go home the same day. I had my left knee done on 10/3/16 and went home on 10/4/16. I think I'll be more comfortable at home. I have my pre-op today at 1pm. I will find out the how they plan on pain management and let you know later today.

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[Jamie]

Outpatient surgery is becoming more common these days as improvements in pain management have come along. As Jaycey indicated, proper pain management is your number one priority before leaving and you need assurance that there is a Plan B in case you are not comfortable with going home the same day. I'm assuming you'll have someone who is with you 24/7 at home for a few days, right?

 

[GottaDoIt]

Thanks everyone. Yes, I have discussed my concerns with my OS and he assures me I will be fine, and yes, there is a Plan B if something did go wrong (the outpatient surgery center is across from a hospital). My home care coach, i.e., husband, is ready to be at my side for the first week or more and I trust him completely. My OS explained the pain management protocols and they sound all good & well while talking about it but then the seed of doubt starts to grow and makes you wonder. Guess I have to remember what I've been reading on this forum, 1) trust the Dr., 2) plan ahead and know what to expect, & 3) listen to my body post-op.

 

[Celle]

As long as there is a back-up plan, should you need to stay in hospital longer, I think you will be OK with out-patient surgery.

 

[birdwatchr]

Gotta answer this one too. I had outpatient tkr.... in at 6am, home by 1pm. I asked Dr about something going wrong. Along with the fact that the hospital is right next door, he basically said the screenings I had had done told him that I was a good candidate for this outpatient surgery, so their experience tells them who would be good for that kind of surgery. It also depends on the answers you would have given him at some point.

As to the pain medications, I did have to call the following morning (Saturday), and the PA called back within 10 minutes. He told me what to do (double the oxycodone) and call back if it did not help.

I would definitely do it outpatient again if I had too. Even though I had no one at home after the weekend (didn't really need them), I would still prefer to be at my own comfortable place where I can get up as needed and not have to wait for someone to bring me medications, or worse, totally ignore me ringing for them. I had everything set out where it was easily gotten to, and could carry it to the place I was sitting/lying down. Even a light lunch of soup was managable.

So.... it all boils down to you. I suppose I could have insisted on a hospital, but I was all for outpatient if it was possible. With you having someone there, if you had to call and they gave a new medicine, you have someone to run out and pick it up. If you are truly uncomfortable with it, mention it to your dr, but I think you'll find you will be ok. They don't release you until you have reached certain "milestones" after recovery. Hope this calms your fears.

 

[IowaNana]

I had no idea they were doing TKR as outpatient, but sounds like you and your Dr have a good plan. The best of luck to you!


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[GottaDoIt]

@birdwatchr Thanks for letting me know your outpatient surgery was successful. Yes, after answering all the screening questions and being in good shape besides a bum knee, I do believe the Outpatient route is right for me. I appreciate the insight from someone who has been down this road.

 

[Jennszoo]

I had outpatient TKR too. Sounds like maybe the same dr as birdwatcher? Lol. I was in by 6, out by 1. Same story that if I was chosen as one of the 30% he recommends for outpatient, then it means I'm a good candidate with a high probability of success. I had some intense pain issues around day 2 with my quad muscle when the block wore off. I saw the PA, got some morphine, eventually got a muscle relaxant on day 7 and have had minimal pain issues since.

I'm thrilled with outpatient, I hate hospitals. Being woken up at all hours, treated like a child who can't go the bathroom alone, etc. (I had my last baby at home, too! That's how much I dont like hospitals. Lol). I was still nervous about not having that safety net, though. But it was fine.

So Id say go for it. Know there's always a plan B if something goes wrong and enjoy sleeping in the comfort of your own home that first night. I'd say your own bed, but I only made it to the downstairs futon those first few days.

 

[dmetz]

Had my pre-op today. Doctor said they make sure before you are released that your pain is controlled. He prescribed norco, tramadol, and a small amount of percoset as backup. Also gabapentin and ibuprofen. So I feel confident that I can come up with a combination that will work. Plus I know I can jump on here and get wonderful advice if need be.

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[Jaycey]

1) trust the Dr., 2) plan ahead and know what to expect, & 3) listen to my body post-op.

You got this one! Sounds like your doc has a plan - that's great. Just be your own advocate and speak up if needed.

 

[GottaDoIt]

@Jennszoo Thanks for the info about your personal experience using an outpatient facility. I agree, hospitals are for the sick and non-healthy, which I am neither.

 

[GottaDoIt]

@dmetz Thanks for your feedback about pain control expectations - similar comments from my doctor who believes I will do fine.

 

[zgard88]

Both of mine total knee's were done outpatient. Absolutely no problems. Surgery at 6:30am and leaving for home at 2pm. He prescribed oxycodone every 4 hours.

 

[GottaDoIt]

@zgard88 Thank you for your comments about the outpatient surgery option. I'm glad to hear others have been pleased with the results and I'm sure I will be too.

 

[missyfit13]

So glad to read the above comments. I'm 73, scheduled for TKR on 12/28 and Kaiser believes in the enhanced recovery, sending patients home same day IF they pass the tests. Hospital is same building so if I stay overnite, they just wheel me over there (private rooms). I'm nervous about getting up in the night to go to bathroom, but otherwise it should be okay. Glad you that have done this are all doing well.