What are the components of a recommended recovery protocol for same-day discharge after joint procedures?

Recovery Protocol Components for Same-Day Discharge After Joint Procedures

For same-day discharge after joint procedures, implement an Enhanced Recovery After Surgery (ERAS) protocol built on five core tenets: limiting preoperative fasting, minimally invasive surgical techniques, multimodal analgesia, early feeding, and early ambulation. 1

Core Protocol Components

Multimodal Analgesia (Critical Foundation)

• Combine multiple medication classes targeting different pain pathways rather than relying on opioids alone 2
• Administer preemptive analgesia before surgical incision 2
• Use periarticular local anesthetic injections intraoperatively 3, 2
• Provide regional nerve blockade when appropriate 2
• Prescribe scheduled non-opioid analgesics (NSAIDs, acetaminophen) with opioids reserved for breakthrough pain only 4
• Consider perineural or incisional catheters with local anesthetic pumps for home use 4

Early Mobilization Requirements

• Patients must be out of bed for 2 hours on the day of surgery 1
• Achieve 6 hours of mobilization per day thereafter until discharge 1
• Extended bed rest increases thromboembolism risk, insulin resistance, muscle loss, and impairs tissue oxygenation 1

Nutritional Management

• Allow oral intake immediately postoperatively—do not require return of bowel sounds 1
• Early feeding reduces length of stay and complications without impairing healing 1
• Remove nasogastric tubes before anesthesia reversal if placed 5

Patient Education (Mandatory Preoperative Component)

• Conduct at least one preoperative visit to set realistic expectations and explain the recovery timeline 6, 7
• Provide detailed instruction on multimodal pain management strategies including nonpharmacologic methods 7
• Patients receiving preoperative pain education report less severe pain in the first 24 hours, fewer medication side effects, and faster return to activities 7

Discharge Criteria and Timing

Clinical Stability Requirements

• Use nurse-led discharge protocols rather than requiring physician evaluation 1
• Patient must be clinically stable without ongoing ischemia, acute kidney injury, LV dysfunction, heart failure, or procedural complications 1
• Adequate pain control achieved with oral medications 1
• No requirement for voiding before discharge in low-risk patients 1
• Mild postoperative confusion in elderly patients should not delay discharge if social circumstances permit 1

Post-Discharge Support

• Ensure responsible adult escort and 24-hour supervision at home 1
• Confirm access to prescribed medications before leaving facility 1
• Arrange follow-up within 48-72 hours 1

Post-Discharge Instructions (Verbal and Written)

Activity Restrictions

• No driving for 24 hours after general anesthesia 1
• No driving until pain and immobility allow safe vehicle control and emergency stop 1
• No alcohol consumption or machinery operation for 24 hours 1
• Avoid long-acting anesthetic agents like isoflurane that require 4-day driving restriction 1

Pain Management at Home

• Provide written analgesic protocols with specific dosing schedules 1
• Instruct on both pharmacologic and nonpharmacologic pain control methods 7
• Consider pre-packaged take-home medications to prevent pharmacy delays 1

Warning Signs Requiring Medical Attention

• Provide written information on complications specific to the procedure 1
• Include contact information for 24-hour surgical team availability 1
• Establish protocols with primary care for postoperative complication management 1

Evidence-Based Outcomes

Implementation of complete ERAS protocols demonstrates significantly reduced length of stay, reduced mortality, and reduced postoperative complications 1. At Kaiser Permanente, orthopedic surgery patients following ERAS protocols showed these improvements compared to traditional care 1. The University of Pittsburgh Medical Center found compliance with five or more ERAS elements associated with improved discharge disposition and reduced mortality at 30 days, 1 year, and 2 years 1.

Modern perioperative protocols enable safe same-day or next-day discharge even after revision joint arthroplasty when patients are appropriately selected, with no increase in 90-day readmissions or emergency department visits 8.

Critical Pitfalls to Avoid

• Do not use traditional discharge criteria requiring bowel function return or mandatory voiding 1
• Do not rely on opioid-only pain management—this increases side effects and delays mobilization 2
• Do not skip preoperative education—this directly impacts postoperative pain control and recovery speed 7
• Do not discharge patients without confirmed adult supervision and medication access 1