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Out Patient Knee Replacement Surgery in Mumbai
- 1. Outpatient Knee Replacement Dr VAIBHAV BAGARIA Director & Head: Dept of Orthopedics Sir HN Reliance Foundation Hospital Initiative President & ND: SICOT India
- 4. Patient Eligibility • Evaluating Co morbidities: Medical comorbidities should be minimal • Scoring System: No rigid Risk stratification criteria - each institute have one of its own.
- 5. Patient Education • Ensure Adequate support at home • Accesibility and ease of approach to home • Anxiety levels about the procedure
- 6. Anesthesia • GA & LA both acceptable • Department should have robust PAC mechanism in place • Measures as short acting Spinals to ensure early mobilisation • Early NBM out to psychologically make patient feel better.
- 8. Analgesia • Starts Preop: gabapentin/ Oxycodone • Its a prerequisite - Pain control with minimal side effects • Pre emptive analgesia important • Multimodal is the name of game.. • LIA ( infiltration) a game changer ! • Steroids/ Anti emetic: Supportive Role
- 9. VTE prophylaxis • Hydration • Early Mobilisation • Calf Stockings or Pneumatic Compression devices • Aspirin for low risk • Novel oral anticoagulant for High risk group
- 10. Blood Loss Management • Pre op optimisation: Hb > 12 • Tranexamic Acid • Controlled Intraop Hypotension • No drains • No discharge if blood loss> 500 • Post op Hb : Day 4 - 7
- 11. Surgical Technique • Surgeons tissue handling skill important • Optimal Surgical Time: Less than 90 min • Wound closure: tight deep layer & subcuticular • Water impervious dressing
- 13. Rehabilitation • Early post operative nutrition and Rehab are Important • To be seen by Physio twice before discharge • Ensure no Postural Hypotension • Telephonic contact after reaching home with physio
- 14. Discharge Criteria • Checklist • Surgical Time • Blood Loss • Pain • Nutrition • Rehab • Patient confidence & enthusiasm
- 15. Emergency Care • Dedicated team to respond to Emergency care need • Telephonic support system
- 16. Home Visit • Routine visit by speciality care nurse: Implementation of Clinical care pathway and check list • Routine visit by Physio and Rehab team
- 19. Are we Ready? • Mind Set? • Emergency Support? • Home Program? • Insurance? • Outcome Measurement: Functional & Brand Building • Analysis of Readmission/ Complication rates • Cost Effectiveness
- 20. The Final Word! Patient Safety is paramount and Non negotiable…