Ten point preoperative checklist for selecting patients for outpatient joint replacement surgery, enumerates study

With advancements in perioperative care, joint replacement (JR) surgery is undergoing a transition from opacified in-patient institutions to nimble out-patient Ambulatory Surgical Centers (ASC). The goal of JR in ASC setting is safe patient discharge with subsequent rehabilitation without readmission. Multi-modal preoperative rehabilitation (MMPR) is a novel field of perioperative care, encompassing comprehensive parameters to ensure smooth transition from fitness for surgery to JR in outpatient setting. At present, there are no open-access schemes for selecting patients qualified for JR in the ASC setting.

In the article, Madhav Chowdhry & Edward J. McPherson proposed an evidence-based, 10-point systematic evaluation of patients with target endpoints for MMPR to qualify patients for JR as an outpatient procedure. It has been published in ‘Arthroplasty’ journal

This checklist is a non-proprietary scheme serving as an initial framework for surgeons exploring surgery in the ASC setting.

The authors introduced factors for a prehabilitation scheme, called Checklist Outpatient-Joint Replacement (CO-JR) to qualify patients for outpatient JR surgery.

These factors have been developed based on an extensive literature review and the significant experience of authors to incorporate variables that drive a successful outpatient JR procedure.

The factors include patient education, psychiatric & cognitive ability, medical fitness, musculoskeletal capability, financial ability, transportation access, patient motivation, information technology (IT) capabilities, along with ability to recover independently at home postoperatively.

The CO-JR scheme is under the process of validation at multiple institutions.

The authors commented – “Our goal is to develop a non-proprietary, open access 10-point CO-JR scheme, developed by the collaborative effort of surgeons across the world, serving as a framework for successfully selecting patients for JR surgery in the ASC setting. We acknowledge that the needs of global populations vary, and the available medical resources are not alike. In the future, we envision a Modified CO-JR for various countries requiring different needs suiting their local ethnic and demographic variances, e.g., Modified CO-JR India, Modified CO-JR Nigeria, Modified CO-JR New Zealand, Modified CO-JR USA etc. The proposed scheme is aimed to serve as a benchmark and is currently under the process of validation. With this initial proposal, we encourage concomitant input and validation to create a common, global platform for JR in the ASC setting. In the future, we would encourage an in-person consensus meeting to further expand this grading system.”

Further reading:

A 10‑point preoperative checklist: selecting patients for outpatient joint replacement surgery.

Chowdhry and McPherson

Arthroplasty (2024) 6:52

https://doi.org/10.1186/s42836-024-00270-2