Making hip and knee surgeries same-day procedures will cause problems, warn patients

Two patients who have had hip or knee replacement surgery warn that the Newfoundland and Labrador government's plan to have some of the procedures done without a hospital stay will lead to discomfort — or even complications.

By the fall, the government aims to have 20 per cent of hip and knee replacement surgeries done as same-day procedures. The goal is to keep hospital beds available for other surgical patients, with waits for joint replacement surgeries among the lengthiest in the province.

Catherine Dempsey, who had both hips replaced a few years ago, says her procedures and recoveries went well but the extra time in hospital helped.

"I had a bit of an oxygen drop so they stuck me in and watched me overnight," she said Monday.

When she had the second surgery done, she had a better idea of what to expect.

"And then I knew this time that when the physiotherapist showed up and asked you to go up and down a step they were going to send you home immediately," she said.

"I was not comfortable at that time. I was feeling worse than I did after the first one so I refused to do the step."

Dempsey said she was discharged after 48 hours in hospital instead of the intended 36 hours at the time. 

Paul Marino said he likely could have gone home after he had surgery to replace both knees two years ago but it would have been difficult because the painkillers he was prescribed were too weak, and being at the hospital allowed him to get something stronger.

"It was very painful and it was a very slow recovery. It wasn't the best."

Pre-pandemic problem

There are about 1,800 people just in the Eastern Health region waiting for hip or knee replacement surgery right now, according to the health authority.

About 1,550 are ready to go immediately, Dr. Will Moores, divisional chief of orthopedics at Eastern Health, said Tuesday.

Moores, who has been a staff surgeon with Eastern Health since 2013, said excluding the first year of building his practice, wait times were generally around one year. Today, he said, wait times for a standard hip or knee replacement are can be upwards of two years.

"There is definitely no shortage of work," he said. 

"I probably wouldn't say that the system has failed. Is it heading that way? It'd be hard to deny it."

The onset of the COVID-19 pandemic cost about six months of lost operation time for hip and knee replacements, said Moores. Some operations went ahead, he said, just not standard elective or joint reconstruction surgeries. 

October's cyberattack on the health-care system knocked hip and knee replacements out of the system for about six weeks, he added.

"You're looking at seven-plus months of the last two years that was lost," he said. 

While long wait times were a problem well before COVID-19, Moores said, the pandemic certainly made things worse.

"Our ability to complete as many joints was actually starting to decrease prior to the pandemic and that is more a factor of the strain on the entire system, in particular with beds and being able to recruit and retain enough nurses to operate those beds," he said. 

Moores said it is becoming common in other places for knee and hip replacement surgeries to become same-day procedures.

Any hospital that wasn't doing so before the pandemic made the switch fairly quickly to maintain capacity while still getting surgeries done, he said.

Moores said the 20 per cent target won't necessarily shorten the overall surgical backlog but will shorten the backlog for a particular population of generally healthier patients..

"We can do more joints and not require more beds," he said. 

"That national guideline for a standard hip and knee replacement is six months.… I think the ideal situation here is our wait time would come down to the national guideline, that if you see a standard hip or knee replacement that you'll be able to reasonably tell them your surgery will be completed approximately six months later."

Read more from CBC Newfoundland and Labrador