January 17, 2019 by John Fernandez
Hip Replacement in the Morning, Home Before Bed
One morning in January, Alex Ojea arrived at Doctors Hospital to have hip replacement surgery — and returned home by the end of the day.
Mr. Ojea’s operation marked the first outpatient hip replacement at a Baptist Health hospital. It was performed by Alexander van der Ven, M.D., an orthopedic surgeon with Miami Orthopedic & Sports Medicine Institute, whose specialties include joint-placement surgery. Since January, Dr. van der Ven has completed two more successful outpatient hip replacements.
In the hands of experienced, skilled surgeons and a special care team, joint replacement as an outpatient procedure is an emerging option that can benefit healthy patients who meet certain criteria, according to the American Association of Knee and Hip Surgeons.
“I loved leaving the hospital as soon as possible,” said Mr. Ojea, 52, (pictured above on the golf course) who needed a hip replacement following complications from a golf injury several years ago. “As soon as I woke up from surgery, they got me up walking. That was amazing.”
He left the hospital able to walk with the use of a walker and started outpatient rehabilitation five days later. “Whatever rehab they prescribed, I would go home and do it another two times. That really helped speed up the recovery,” Mr. Ojea said.
Mr. Ojea, a competitive golfer who has won 13 tournaments on the Golf Channel Amateur Tour, was the perfect candidate for Baptist Health’s first outpatient hip replacement. “He was healthy and motivated to get better quickly and he had support at home,” Dr. van der Ven said. “He wanted to be home in his own bed. He wanted to get back to playing golf.”
Regaining Independence Quickly
Indeed, Mr. Ojea, who played professional baseball in the mid-1980s, competed in a golf tournament five weeks after his surgery.
The other two patients, a 48-year-old woman and a 63-year-old woman, also had good experiences leaving the hospital on the same day as their hip replacements, said Lizbeth Torres, R.N., a patient care supervisor who is leading Doctors Hospital’s Home in 16 Hours project.
“Most patients are, in fact, candidates for outpatient hip replacement,” Dr. van der Ven said. “We want to treat these patients like healthy people and help them regain their quality of life and independence quickly. Hospitals are meant for sick people, not for healthy people.”
No patient, however, is required to have a hip replacement as an outpatient. “A lot of patients are afraid and family members are skeptical, too,” Dr. van der Ven said. “It takes a patient who is motivated to do this. We don’t want to force patients out of the hospital if they’re not ready. We want to accommodate patients, and this is a way to accommodate certain patients.”
Five years ago, the average stay at Doctors Hospital following a hip replacement was six days; today it’s two days, Dr. van der Ven said. Outpatient joint replacement is a “very recent trend,” made possible by improvements in surgical technique, the management of anesthesia and pain, and the care-team process. Dr. van der Ven uses a less-invasive surgical technique that avoids cutting through muscle, results in less blood loss and reduces post-surgical pain.
Ms. Torres, the patient care supervisor, conferred with Dr. van der Ven about the possibility of offering outpatient hip replacement after Doctors Hospital nurse Teresita Noriega, R.N., learned about it at an orthopedic nursing conference. With Dr. van der Ven’s support, Ms. Torres put together a multidisciplinary team consisting of nurses, a dietitian, physical and occupational therapists, and representatives from the preplanning, ambulatory surgery, operating room, anesthesia departments and social work departments. The team created the process that would make outpatient hip replacements possible.
‘Everything Is Accelerated’
Patients who are interested in going home the same day as their surgery attend an educational planning class to learn about the process and determine if they are good candidates. Orthopedic nurse practitioner Jessica Heligman and Ms. Torres meet with the patients before their surgery and follow their progress closely during their stay.
Outpatient joint replacements are scheduled first thing in the morning, and every member of the team has a role to keep things on track so the patient, if well enough, can leave before 9 p.m.
“Everything is accelerated,” Ms. Torres said. “As soon as the patient arrives at the hospital, all the departments are made aware.”
When the patient is ready to go home, he or she is given the direct phone numbers of Ms. Torres and Ms. Heligman, who remain available 24/7 to answer any questions or concerns. They also call the patient at home to follow up on their progress. “The most important thing is that they feel safe at home,” Ms. Torres said.
Benefits of Outpatient Surgery
Outpatient surgery offers many benefits, she said, including a lower risk of infection, not being disturbed when nurses do their hourly rounds in the middle of the night and the familiarity and comfort of the home bed and environment. “If you sleep better,” Ms. Torres said, “you will heal faster.”
Mr. Ojea agreed. “You are so much more comfortable in your home in your own bed,” he said. “It’s like night and day.”
And after living and playing golf in pain following his hip injury, he’s enjoying life with his new prosthetic hip joint. “I feel like a new man,” Mr. Ojea said. “I play golf every day. I hadn’t been able to cross my legs in two years. Now, there’s nothing I can’t do.”