Table 1 Proposed 10-point checklist for surgeons to enrol patients for joint replacement surgery in an outpatient setting

1

Patient Education: Illness Coherence and Procedure Awareness

Patient understands all aspects of JR Procedure, Recovery and his/her individual responsibility in this process

Patient is evaluated for baseline psychological distress [19, 20], perception of illness (illness coherence) [21] and expectations of 24-h discharge following surgery [22,23,24]

Video tutorials or telemedicine class

Final coordinator interview/1-on-1 session with patient

Yes = 1

No = 0

2

Patient Motivation

Patient acknowledges the need for self-improvement and commitment to rehabilitation. The goal is to return to independent living [25,26,27]

Patient articulates willingness to participate in Outpatient surgery protocol [23]

Reading a standardized script and assessing willingness to participate via a 10-point Modified Likert Scale (with 0 = unmotivated, unwilling and 10 = highly motivated, highly willing). A score of ≥ 5 would be sufficient to proceed with the surgery [26]

Yes = 1

No = 0

3

Medical Fitness, Habits, Nutrition

Optimization of all medical comorbidities [28, 29]

Normal albumin [30,31,32,33] and vitamin levels

Negative Cotinine levels

No Opiates/Tramadol within 4 months of surgery

Initiate starting an anti-inflammatory diet [30, 34]

Full capability to withstand surgical stress and postoperative anaemia & engage in rehabilitation (home and clinic)

Comprehensive Serum Laboratory testing and BMI \(\le\) 32

WNL

Yes = 1

All six categories are fulfilled

Serum albumin [31,32,33]

 ≥ 3.5 g/dL

HbA1C levels

 ≤ 7%

Serum Cotinine [35, 36]

 < 8 ng/dL

No = 0

STOP-Bang Index (Sleep Apnoea survey) [37]

0–2

UCLA Patient Medical Risk Stratification

 < 3

4

Physical Musculoskeletal Capability

Maximize preoperative strength, balance, agility without causing debilitating pain and joint inflammation

Minimising postoperative fall risk

Preoperative pain and inflammation must be kept at a minimum to avoid postoperative edema and excess pain cycle

6 Minute Walk Test (with/without aid) [38]

Yes

Yes = 1

Both categories were fulfilled

CMT (Table 2): \(\ge\) 7 sit-to-stand repetitions in 30 s

Yes

No = 0

5

Computer & Internet Capability

Able to engage in Telemedicine Visits Independently

Interview & in-home assessment for telemedicine

Yes (able) = 1

No (Not able) = 0

6

Perioperative In-Home Support

Designated, on-demand, 24 × 7 (home-aid/family member) support available for 8 weeks post-op

Interview with patient, family & PCP to ensure such availability

Yes (arranged) = 1

No (Not arranged) = 0

7

Transportation

On-demand access in a timely fashion for scheduled and unscheduled healthcare visits

Interview with patient & preoperative transportation status evaluation

Yes (available) = 1

No (Not available) = 0

8

Financial Ability

Ability to cover all expected and unexpected charges related to joint recovery

Ability to pre-pay down payment for surgical procedure

Occupational “time off” benefits (to include designated family helper)

Interview with a financial coordinator

Yes (Can cover) = 1

No (Cannot cover) = 0

9

Postoperative Self Sufficiency

Patient is self-sufficient and willing to engage during the recovery phase

Interview with patient, family & PCP

In-home assessment for food stores and hygiene

Yes (Capable) = 1

No (Not capable) = 0

10

Perioperative Cognitive Ability

Low likelihood to become confused and/or disoriented after going home from surgery

No history of postoperative delirium

No dementia & fully engaged in preoperative evaluation process

CAM (Confusion Assessment Method) [39] by Nurse navigator

 < 2

Yes (Pass) = 1

No (Fail) = 0