Outpatient TKR

[Celle]

A knee replacement is major surgery and there is no way I would contemplate having it on an outpatient basis. I have a minor bleeding disorder, so it would not ever be considered for me anyway. I had an IV drip for 24 hours after the operation, so that a vein was available, should I need a blood transfusion.

I know that there is a risk of picking up an infection while in hospital, but this has to be balanced against other post-operative risks in the first 24-48 hours, as Josephine said.

I also think that there is a risk of people minimizing the severity of the operation, thinking that "It can't be too serious, because they do it as an outpatient procedure." That could lead to expectations from the person operated on and from their friends and family that there will be a fast recovery from the operation. Not so! It's a long recovery period, requiring lots of patience.

 

[jeano]

True enough but back in prehistoric days when I was born childbirth was considered to be a medical crisis that required days and days and days in the hospital for mother and babe, babies didnt room in with their moms, and people who had cataract surgery were required to lay flat with their heads sandbagged to prevent movement, cqrdiac patients were prescribed strict rest..things can and do change in health care, often for the better. At present theres a big upswing in outpatient surgeries; they are becoming more routine even for big operations. Its possible that this is at least partly due to better outcomes for patients.

My least favorite work experience as an RN involved being pulled to an orthopedic floor and caring for a patient who had a persistent infection seated in the pins holding their leg bones together, very nasty. That alone may have predisposed me to seek to spend as little time in the hospital as humanly possible for my very own orthopedic surgery.

 

[Lovestoread]

I know I'm very much in the minority here, but I had mine done and came home the same day…twice. Mine was done at a well-known teaching hospital (not sure if I'd do it this way in just a local hospital, but I was fortunate to live near the hospital) and I had no problems at all. Surgery was from approximately 8:30-10:00 am. I was in a room by 11. PT came at noon and I walked up and down a full flight of stairs and up and down the hall on the floor. I was on my way home by 1:30. As for my incision, it was glued, so I really didn't have any dressings to worry about. I had received all of my pain meds ahead of time and was sent home with an ice machine. The following day, a nurse came to the house (and came three times a week for a couple of weeks) as well as a physical therapist. I had home therapy for about two and a half weeks, at which time I began out-patient therapy. I did spend much of the day with my beloved ice-machine and kept my leg elevated as much as possible. I believe I was very fortunate in that my pain was minimal both times….not much more than when I had my knees scoped. My surgery was done minimally-invasively, meaning no muscles, tendons or ligaments were cut. I've had no problems to speak of, other than some IT band pain, which I work on every day. This type of surgery is not for everyone, but for me, it was great. I have pretty serious insomnia, and I knew there was no way I'd sleep at the hospital and was just more comfortable recuperating at home. My husband took a week off of work to be with me and that worked just fine. I was certainly able to manage on my own after that.

 

[RedRider]

Interesting to see the reservations of an "outpatient" TKR/PKR there are out there.

My OS informed me that my bi-compartmental will be performed in an outpatient setting. Of course I question the emergency preparedness of such a facility, but the infection rate alone (compared to a general hospital) was appealing. Transfusions, coagulation issues and pain management are factors as well but given the prevalence of nosocomial infections in a hospital setting, outpatient PKR's and even TKR's may be the wave of the future.

 

[jeano]

My now 89 year old mother had laser reattachment of a detached retina in an outpatient setting a few years back--I'm sure that they felt and were adequately prepared to deal with anything that might arise when dealing with a medically compromised ancient lady--not to mention that the facility was maybe a 5 minute ride from a major hospital. My former boss has had a couple of procedures at a shiny orthopedic practice that has its own operating suites--and again, is a few minutes at most away from about 3 hospitals including a Level I trauma center.

Most if not all of the outpatient surgery venues I know of are similarly close to EDs and ICUs of all descriptions, and, face it, they are NOT committing surgery on anyone unless the patient is medically clear for the procedure. Since they have the capacity to administer anesthesia of all types they by defiinition have what I would consider to be "emergency preparedness" -- I would define this as the ability to provide an airway, deliver oxygen, monitor vital signs, control bleeding, treat shock, give drugs quickly via an IV, and have a defibrillator, drugs and other paraphernalia that would be handy in the event that a patient decides it is time to expire during the procedure.

You are probably safer having outpatient surgery, even detached from a hospital, then you are driving your car or sitting in church. I know people worry a great deal about the what ifs after surgery but surely we have all read or God forbid experienced horror stories about neglect of pain relief, safety issues, inadequate staffing to meet patient needs and so on DURING hospitalization. No, outpatient surgery may not be for everyone and certainly wont apply for a lot of procedures, but I think a lot of folks will need to get their heads wrapped around the concept sooner than they think.

 

[kzjay]

Thank you for all of your replies. I certainly appreciate the feedback of those who have had TKR as an outpatient procedure. I understand that this surgery could not be done on all patients as outpatient but I am confident in the doctor and orthopedic practice that I have chosen. Based on my age (49) and the fact that I do not have any other health conditions they said that I was the best type of candidate for having the surgery and going home the same day.
I also am no stranger to outpatient surgeries having had 4 of my 6 knee surgeries that way. The only ones that I stayed in the hospital for were the first two that were done in 81 and 82. I was fortunate enough that they had just started doing scopes on knees for my torn meniscus but the hospital stay at that time was 7 days. Then I was on crutches for 4 weeks. In 1996 I once again had both knees scoped with torn meniscus removed and the bone smoothed out. I walked out of the facility without any assistance within hours of the procedure. That was on a Thursday and I was back to work on Monday compared to missing a whole month of my senior year of high school with the first surgeries. It is amazing how much protocols have changed over the years.
I do understand that this obviously much more than a knee scope and I am gathering all the information that I can to be prepared as possible. My husband is taking the first two weeks off of work to stay with me and I also have an 18 year old son who is still at home that will be there to help as well. I do have a very high pain tolerance so I believe pain management will not be an issue. I also have the benefit of having a daughter-in-law who is an OT and her father (a long time family friend) is a PT who will be treating me afterwards.
Surgery is now less than 11 weeks away and I am starting to prepare my home for my recovery and I am looking forward to getting back to a much more active life without the pain and limitations that I currently have. I will certainly keep coming to this forum as I have found it to be one of the most positive and informative out there.

 

[referee54]

I seriously cannot comprehend having total knee replacement as an outpatient surgery.

I know that is has been done, but I feel the same way; there is no way that I would have been ready to come home so soon.

and frankly I can't remember anything of that Hospital time except being totally helpless.

I wasn't totally helpless, but I could not do much for myself, and my wife was not able to help that much, as she had to go to work.

 

[isledancer]

I healed very quickly following tkr. But I was happy to still b in hospital on day 2 when I needed a transfusion !

 

[Florida 1]

I wouldn't recommend outpatient because of my experience with getting weak, passing out and needing a blood transfusion after my first TKR. They were somewhat prepared the second time and checked my blood levels and gave me a transfusion on day 2 (before I passed out this time!). But until I passed out the first time, a transfusion wasn't even on the radar. I can't imagine passing out at home 1 day post TKR - my husband would probably have called 911! And I too had a problem with blood running down my legs both times from my incisions.

 

[1ELISEA]

@kzjay
How goes the preparation for surgery?
Anything that we can help you with to get ready?

 

[WyrDachs]

I'm a pretty tough chickie and I can't imagine going home, as outpatient, after a TKR. I was glad I was in the hospital for a couple of days, for the pain control alone.

I was a couple days in the hospital, then transferred to inpatient rehab, total was approx 8 days total.

 

[Whimsy3]

I had no major issues in the hospital, but I could not imagine going home the same day. I think the reason I had no issues is because I was in the hospital with a trained and caring staff. I was on a joint replacement ward and they were very knowledgeable. I had surgery on Tuesday and came home Friday.

 

[RunA42K]

I am another one who cannot imagine out patient TKR. I am thinking about the pain control. Every surgery is different so no one knows for sure how their recovery will go. My TKR I was in the hospital for 4 nights and 5 days. There was no way that I wanted to go home sooner. Too much pain. But then I had a revision on December2, and I only stayed two nights and went home at midday on the 3rd day. The revision, I did not have pain and swelling at all compared to that first TKR. I was fine with going home after two nights, besides I had already been through it, and my husband (my caregiver), we knew what to expect and what to prepare for. It was a pleasant surprise that my recovery is going so well. Who knew? I was expecting the worst again...but now I can say, Who Knows?

 

[Campervan]

Even if I hadn't had tubes poking out of various places around my body I wouldn't have wanted to get out on the same day. I got light headed and nauseous for a couple of day. I spend 4 nights in hospital but I think I'd have been comfortable leaving after two nights, and definitely after three. When surgery was booked I was told I'd be in for five nights.

I wonder sometimes if insurance companies are driving the length of hospital stays down by the amount they will fund.