Practice Variations in Anesthetic Care and Its Effect on Clinical Outcomes for Primary Total Hip Arthroplasties

Gabriel, Rodney A.; Kaye, Alan D.; Jones, Mark R.; Dutton, Richard P.; Urman, Richard D.

doi:10.1016/j.arth.2015.08.031

Cited by 15 publications

(11 citation statements)

References 18 publications

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“…The process of case identification reflects clinical care for THR: 23% received RA (mostly neuraxial procedures), 14% received GA + RA, and 63% received GA. U.S. registry analyses report similar proportions of GA and RA use in THR . Their demographic data are comparable to ours.…”

Section: Discussionsupporting

confidence: 80%

Regional vs. General Anesthesia for Total Knee and Hip Replacement: An Analysis of Postoperative Pain Perception from the International PAIN OUT Registry

et al. 2018

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Section: Discussionsupporting

confidence: 80%

Regional vs. General Anesthesia for Total Knee and Hip Replacement: An Analysis of Postoperative Pain Perception from the International PAIN OUT Registry

et al. 2018

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“…The results of our study suggest that CI is an important and underappreciated factor in patient recovery after elective THA [39]. Routine pre-operative screening currently focuses on organ system dysfunction that may result in immediate complications.…”

Section: Implications For Clinical Practicementioning

confidence: 74%

Cognitive impairment and postoperative outcomes in patients undergoing primary total hip arthroplasty: A systematic review

Viramontes

Erfe

et al. 2019

Journal of Clinical Anesthesia

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Total hip arthroplasty (THA) is a common surgical procedure in the elderly. Varying degrees of cognitive impairment (CI) are frequently seen in this patient population. To date, there has been no systematic review of the literature specifically examining the impact of CI on outcomes after elective THA. The aim of this systematic review was to identify studies that compare the postoperative outcomes of patients with and without CI after undergoing elective primary THA. Design: We conducted a systematic review of prospective and retrospective studies. A systematic literature review was conducted by searching MEDLINE, PubMed, and Embase from between January 1, 1997 and January 1, 2018. A total of 234 articles were reviewed and 22 studies were selected. Setting: Operating room and short-term and long-term postoperative recovery up to 2 years. Patients: Patients with CI who underwent an elective primary THA that required general anesthesia with a comparator group of patients who did not have dementia. Interventions: Patients who underwent elective primary total hip arthroplasty. Measurements: Outcomes included post-operative delirium (POD), mortality and other complications, discharge disposition, length of stay (LOS), mortality, short-term (30 days) and long-term (1 month-2 years) complications. Main results: 22 studies with 5,705,302 participants were included in the systematic review. Sample sizes varied greatly, ranging from 14 to 2,924,995 participants. There was an association between patients with CI and an increase in POD, in-hospital mortality, complications during hospitalization, non-routine disposition, LOS, mortality between 1 month to 2 years, and worse postoperative functional status. Conclusions: We demonstrate that there are strong associations between patients with pre-existing CI undergoing THA and increased POD, hospital mortality, hospital complications, and hospital LOS. We report good quality evidence linking complications after THA to preexisting CI. Screening for CI can improve care and better predict the risk of developing postoperative complications such as delirium. Further investigations can address perioperative factors that can help reduce complications and show the utility of more widespread assessment of preoperative cognitive impairment.

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“…Significant institutional variability exists in perioperative anesthetic and postoperative analgesic regimens for arthroplasty, 56,58,61 with general anesthesia being the most common anesthetic modality. 62,63 Therefore, the administration of PCOA may be associated with differing outcomes in other centres. Our centre uses guidelinerecommended multimodal analgesia regimens 64,65 that play a role in keeping PCOA failure rates low.…”

Section: Generalizability Of Resultsmentioning

confidence: 99%

Factors associated with success and failure of patient-controlled oral analgesia after total hip and knee arthroplasty: a historical comparative cohort study

Vorobeichik

Hoydonckx

Kumar

et al. 2020

Can J Anesth/J Can Anesth

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Purpose Patient-controlled oral analgesia (PCOA) is a novel method of oral opioid administration using set doses of short-acting oral opioids self-administered by patients with a ''lockout'' period as part of a multimodal regimen. Failure of PCOA can result in severe postoperative pain necessitating use of intravenous patient-controlled analgesia (IV-PCA) with its potential complications. This study evaluated factors related to success or failure of PCOA following total hip arthroplasty (THA) and total knee arthroplasty (TKA). Methods We conducted a retrospective cohort study of all adults who underwent THA and TKA at our institution by extracting data from the proprietary database of our acute pain service. Patient, anesthetic, and surgical variables associated with PCOA failure defined as inadequate analgesia requiring conversion to IV-PCA within 24 hr following THA and TKA were evaluated. Univariable and multivariable logistic regression analyses were performed to identify predictors of PCOA failure.

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Practice Variations in Anesthetic Care and Its Effect on Clinical Outcomes for Primary Total Hip Arthroplasties

Cited by 15 publications

References 18 publications

Regional vs. General Anesthesia for Total Knee and Hip Replacement: An Analysis of Postoperative Pain Perception from the International PAIN OUT Registry

Regional vs. General Anesthesia for Total Knee and Hip Replacement: An Analysis of Postoperative Pain Perception from the International PAIN OUT Registry

Cognitive impairment and postoperative outcomes in patients undergoing primary total hip arthroplasty: A systematic review

Factors associated with success and failure of patient-controlled oral analgesia after total hip and knee arthroplasty: a historical comparative cohort study

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