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Demand for joint replacements in Australia has more than doubled in the past ten years, with 22.5 percent of older Australians and 3.4 percent of the general population now requiring the surgery.
As longevity and rates of obesity increase, the health burden of joint replacements is set to rise enormously. By 2030, total knee and hip replacements – which are among the most common subtypes – will rise by 276 and 208 percent, respectively, costing the healthcare system $5.32 billion. The private sector will foot most of this bill, at $3.54 billion.
Associate Professor Sol Qurashi of The Hip and Knee Clinic at Harbourcity Orthopaedics says these figures highlight the need to adopt sustainable models of care like Enhanced Recovery After Surgery (ERAS) within joint replacement.
ERAS – a model which has proven successful in other specialties – uses a number of interventions throughout the patient’s joint replacement journey, with the aim of reducing physiological stress associated with surgery. These include patient education, microsurgical techniques, a modified anaesthetic regimen, and postoperative patient services.
As well as improving health outcomes and patient satisfaction, this method can deliver lower costs, shorter hospital stays and a quicker return to function. For these reasons, it could help ease the health burden of joint replacements, A/Prof Qurashi argued, but only if used with caution.
“ERAS aims to make the surgery a gentler experience for the patient and reduce the surgical insult on their body. We have seen it deliver health and economic benefits in other well established models of care in the US and Europe. Not just in orthopaedics, but in other specialties like abdominal surgery.
“That said, it could easily do the opposite and potentially prove disastrous if it is not handled appropriately.”
Clinically-led approach
The right resources, skillset and meticulous patient selection are some of the prerequisites of ERAS within joint replacement. Failure to meet these could result in adverse events such as readmissions, lengthier hospital stays and greater expenditure. For these reasons, ERAS-related decisions should always come from clinicians, A/Prof Qurashi stressed.
“Patient focussed outcomes must always be the primary goal. We need to double emphasise that whilst the ERAS methodology can be applied to all, certain elements of this model – such as early discharge – are not for everyone. Nor is it a default approach that only excludes some people. It should be tailored to the patient and delivered on a case-by-case basis – but often with clear patterns on who may be a good fit,” A/Prof Qurashi said.
“Say you have patient X, who is 87 years of age, lives alone, and has heart disease. Sending that patient home on the day after a joint replacement may be asking for trouble. They may benefit from a longer hospital stay and inpatient rehab for an extended period of time. In contrast, you have patient Y, who is 65, very motivated, in good health and with good family support. He or she could be an ideal candidate for ERAS.”
A clear need
Despite the challenges and pitfalls of ERAS, A/Prof Qurashi believes healthcare institutions and stakeholders cannot afford to dismiss it as a mainstream option for managing joint replacement.
“Yes, there are major considerations, but a well-managed ERAS approach will ultimately benefit everyone. Patients will have equally good if not better outcomes, will be more satisfied, resources will go further and expenditure will be drastically reduced. In my view, it is a no-brainer.”
Associate Professor Sol Qurashi is a Sydney based Hip and Knee Surgeon and one of the pioneers of enhanced and rapid recovery methods in joint replacement surgery in Australia, having performed the first ‘Day Only’ (same day discharge) hip replacement in 2018. He is also one of the first to start an outpatient (going home same day as surgery) Hip replacement and Knee replacement program in the country and has been performing Overnight Stay Joint replacement surgery since 2014 with excellent results.
A/Prof Qurashi is due to present at the Health Insurance Summit where he will dive deeper into the pros and cons of ERAS from a private health perspective.
Joining A/Prof Qurashi on the stage are representatives from the Australian Government, RACGP, Medibank, nib and many others.
This year’s event will be held 27-28 June 2023 at the Amora Hotel Jamison, Sydney.
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