New 10-point checklist aims to streamline patient selection for outpatient joint replacement

Editor's Note

As joint replacement (JR) procedures increasingly move from the hospital setting to ambulatory surgical centers (ASCs), selecting the right candidates for these outpatient procedures becomes crucial. To support this transition, study authors Madhav Chowdhry, MD, and Edward J. McPherson, MD, developed a comprehensive, evidence-based checklist called Checklist Outpatient-Joint Replacement (CO-JR), designed to identify suitable patients for outpatient JR in ASCs. It was published by the journal Arthroplasty in September 2024, in a study titled, "A 10-point preoperative checklist: Selecting patients for outpatient joint replacement surgery.”

The CO-JR considers patient attributes such as psychiatric and cognitive ability, physical fitness, motivation, transportation access, and the ability to recover independently at home. It also addresses practical factors such as a patient's financial situation and their ability to use technology (IT skills) as part of determining whether they are suitable for an outpatient JR procedure. Financial feasibility is important because outpatient procedures may involve costs not be fully covered by insurance, and a patient’s financial preparedness can impact their follow-up care and recovery, noted the study. Meanwhile, IT skills can play a role in a successful outcome if, for example, patients need to use digital platforms for remote check-ins, access post-op care instructions, or communicate with healthcare providers.

The overall goal of the CO-JR is to reduce hospital stays and support rehabilitation without readmission. The checklist is open-access and intended as a foundational tool, adaptable to regional variations and differing healthcare resources globally. While the checklist has yet to undergo full validation in clinical trials, the authors see it as a flexible starting point, promoting collaboration and feedback from surgeons, physical therapists, and other perioperative professionals. By encouraging broad adoption and input, the authors hope to refine CO-JR into an internationally recognized framework, allowing for local adaptations tailored to specific patient demographics.