A study from Northside Hospital in Atlanta and reported on in Anesthesiology News showed that a high percentage of Hip and Knee replacement patients can be successfully discharged on the day of surgery using a Multi-Modal Analgesic Protocol (MMAP). Over 2,000 patients were analyzed and 85% were discharged within eight hours of their procedure. Approximately 70% of patients not taking narcotics preoperatively did not require their use in the postoperative period. Success was attributed to the close working relationships between surgeons and anesthesiologists, the use of a strict MMAP with the use of spinal anesthesia, and full institutional support. A Pre, Intra and Post-Operative MMAP protocol summary is provided in the article. The lead author emphasized that a dedicated multidisciplinary team as well as patient education are key components of successful same day discharge for patients undergoing joint replacements.
EHC NOTE: The approach described, which was able to facilitate same day discharge for joint replacements, is likely to expand to other traditionally inpatient procedures due to cost pressures and advances in surgical technique and pain control. The study discussed is instructive in that a multi-disciplinary team approach in conjunction with a narcotic light multi-modal analgesic protocol facilitated the results. Institutions looking to achieve same day discharge for joint replacements or other procedures are advised to review the approach taken at Northside Hospital and adapt it to their local clinical and operational environment.