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4/2023
vol. 55
abstract:
Original article
Standards of perioperative management in total knee and hip arthroplasty procedures. A survey-based study. Part I: Preoperative management
Izabela Pabjańczyk
1, 2
,
Halina Kutaj-Wąsikowska
4
,
Agnieszka Mastalerz-Migas
7
,
Wojciech Józef Marczyński
10
,
- Department of Intensive Care and Anaesthesiology, 5th Military Hospital with Polyclinic, Cracow, Poland
- Centre for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Cracow, Poland
- Department of Anaesthesiology and Intensive Care, Medical University of Gdańsk, Poland
- National Centre for Quality Assessment in Healthcare, Cracow, Poland
- Department of Anaesthesiology and Intensive Care, Ludwik Rydygier Specialist Hospital in Cracow, Poland
- Department of Medical Education, Jagiellonian University Medical College, Cracow, Poland
- Department of Family Medicine, Wroclaw Medical University, Poland
- Sports Medicine Centre, Zabrze, Poland
- Department of Orthopaedics, Paediatric Orthopaedics and Traumatology of the Centre of Postgraduate Medical Education, Adam Gruca Public Research and Teaching Hospital in Otwock, Poland
- Centre of Postgraduate Medical Education, Warsaw, Poland
- Orthopaedic and Trauma Surgery Clinic, 5th Military Hospital with Polyclinic (Independent Public Health Care Institution) in Cracow, Poland
- 2nd Department of Anaesthesiology and Intensive Therapy, Medical University of Lublin, Poland
Anaesthesiol Intensive Ther 2023; 55, 4: 262–271
Online publish date: 2023/11/28
PlumX metrics:
Introduction:
Recent 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 methods:
With 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.
Results:
A 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.
Conclusions:
The 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.
keywords:
TKA, ERAS, THA, knee, replacement, surveys and questionnaires, hip, arthroplasty, perioperative medicine, medical overuse
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