Standards of perioperative management in total knee and hip arthroplasty procedures. A survey-based study. Part I: Preoperative management

• DOI: 10.5114/ait.2023.132832
• Publication Date: 2023-11-28T09:44:41Z
• Authors: Izabela Pabjańczyk; Radosław Owczuk; Halina Kutaj-Wąsi...; Jakub Fronczek; Krzysztof Węgrzyn; Monika Jasińska; Paweł Jarocki; Wojciech Mudyna; Agnieszka Mastale...; Zbigniew Pilecki; Jarosław Czubak; Wojciech Józef Ma...; Sebastian Nowak; Mirosław Czuczwar; Wojciech Szczeklik
• Keywords: THA; tha; hip; tka; RC86-88.9; TKA; Arthroplasty, Replacement, Hip; perioperative medicine; knee; eras; Medical emergencies. Critical care. Intensive care. First aid; replacement; 3. Good health; Original and Clinical Articles; Anesthesiology; Surveys and Questionnaires; surveys and questionnaires; arthroplasty; Humans; RD78.3-87.3; ERAS; Arthroplasty, Replacement, Knee; medical overuse

IntroductionRecent years have seen an increasing number of elective total knee (TKA) and hip arthroplasty (THA) procedures. Since a wide variety of methods and procedures are used in perioperative management, a survey-based study was carried out to identify the patterns of practice in Polish hospitals.Material and methodsWith the help of the LimeSurvey application, questionnaires for anaesthesio­logists and orthopaedists were prepared to gain insight into the preparation of patients for TKA and THA procedures and perioperative care. Questionnaires included both single and multiple-choice questions concerning among other things type of laboratory tests, additional examinations and consultations performed on a routine basis before elective TKA and THA procedures.ResultsA total of 162 medical centres took part in the study. Questionnaire responses were obtained from 93 (57%) orthopaedics teams and 112 (69%) anaesthesiology teams. A mean (standard deviation, SD) of 7.2 (3.5) laboratory tests are routinely ordered before surgery. For example, 47% of orthopaedists and 20% of anaesthesiologists order urinalysis, while 53% of orthopaedists and 26% of anaesthesiologists order a CRP test. Seventy-nine per cent of orthopaedists refer patients for at least one specialist consultation before the procedure. Dental consultation is requested by 40%, gynaecological consultation by 27%. Patient preoperative education is provided by 85% of orthopaedists and preoperative rehabilitation is prescribed by 46% of them. A total of 56% surveyed anaesthesiologists perform pre-anaesthetic evaluation upon patients’ hospital admission.ConclusionsThe study found that the number of examinations and specialist consultations conducted in Polish hospitals exceeded the scope of recommendations of scientific societies. Furthermore, the authors identified a need to standardise perioperative management in the form of Polish guidelines or recommendations, with the intention to improve patient safety and optimize health care expenses.