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Vital Signs

Fall 2009

Advances Allow More Outpatient Orthopaedic Surgeries, Shorter Hospital Stays


Ortho Surgery Whether it is repairing a torn rotator cuff in the shoulder of an athlete after a fall or replacing the arthritic hip of an older adult, orthopaedic procedures are increasingly being performed on an outpatient basis or with only a few days of recovery in the hospital, says Robert Pedowitz, M.D., Ph.D., the new chair of orthopaedic surgery at UCLA.

“More and more adult non-trauma-related orthopaedic surgery is moving toward being done as ambulatory procedures, or involves techniques that require a much shorter stay in the hospital,” Dr. Pedowitz says. “Some complex procedures that used to mean a week or more of hospitalization now require only a couple of days. I can envision a time soon when some of these will require only a same-day or overnight stay.”

Knee-repair surgery is a good example of this trend. “When I first did ACL (anterior cruciate ligament) surgery, patients would stay in the hospital for five days,” Dr. Pedowitz says. “Now, routinely, we send them home the same day.”

And age does not appear to be a limitation. “We can do procedures on people who are in their 70s and 80s and still send them home within the same day,” he says. “As long as the patient is fundamentally healthy — they have a healthy heart and they haven’t lost a lot of blood during surgery — then what do they need to stay in the hospital for?”

This trend has been made possible by improvements in surgical techniques, including minimally invasive arthroscopic procedures that require smaller incisions, spare muscle and result in less blood loss and trauma to patients, as well as better medications to control pain, Dr. Pedowitz says. “Patients love it because they are able to recover in their own surroundings, where they are most comfortable, and it is medically safe.”

And while complex procedures such as hip and knee replacements are not yet able to be routinely performed as outpatient procedures, the newer surgical techniques and specialized instruments make it possible for many patients to leave the hospital sooner after surgery. UCLA orthopaedic surgeon Eric E. Johnson, M.D., for example, often performs total hip replacements through the front (anterior) of the hip rather than from the back (posterior), and he has observed that some patients have demonstrated a faster recovery. Similar results have been noted with improved, less invasive techniques that approach the hip more traditionally from the back.

Trend in Ortho SurgeryAn important complement to these newer surgical techniques is the combination with regional anesthesia that helps with pain control and avoids some of the side effects of more traditional anesthetic techniques. Daniel A. Oakes, M.D., chief of the UCLA Joint Replacement Service, notes that close to 90 percent of the hip and knee replacements done at UCLA are performed under regional anesthesia. “I think we have come to fully appreciate how immediate post-op pain control can improve a patient’s recovery even three or four weeks from surgery,” Dr. Oakes says. “We have made significant strides to shorten hospital stays and get patients into their home environments sooner.”

UCLA’s orthopaedics service is focused primarily at UCLA Medical Center, Santa Monica, where plans are to expand the capacity for outpatient surgeries.

Visit UCLA orthopaedic website at:  www.ortho.ucla.edu

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