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Patient education and anesthesia choice for total knee arthroplasty

https://doi.org/10.1016/j.pec.2017.04.014Get rights and content

Highlights

  • Spinal anesthesia (SA) may be associated with improved outcomes in TKA.

  • Rate of SA in the US is only around 25%.

  • Lack of information about SA may be a barrier to its increased use.

  • “Joints class” is a preoperative educational session offering anesthesia information.

  • Attendance of the joints class was associated with increase in the rate of SA.

Abstract

Objectives

Spinal anesthesia (SA) for Total Knee Arthroplasty (TKA) may be associated with better patients’ outcomes. This study aims to assess the association between preoperative education about the advantage of SA over general anesthesia (GA) for TKA and the likelihood of patient choice of NA.

Methods

Patients undergoing unilateral primary TKA were identified. Type of anesthesia (GA or SA), attendance of the (joints class), patient demographics, ASA status, anticoagulation status, and diagnosis of back problems were recoded. Regression analysis was used to assess the association between the type of anesthesia and attendance of the joints class.

Results

1010 patients were identified to have unilateral primary TKA. 31% of patients attended the joint class. Patients who attended the joints class were more likely to receive SA when compared to those who did not attend (OR = 1.7, CI: 1.2–2.5, P = 0.004) after adjusting for other variables.

Conclusion

Preoperative education about advantages of SA may be associated with an increase in patients receiving SA for TKA.

Practice implications

Increase in patients receiving SA for TKA may improve outcomes.

Introduction

Over 600,000 total knee arthroplasty (TKA) is performed annually in the United States (US). This number is projected to increase 6 fold by 2030 [1]. Similar trends have been observed in European and other developed countries [2]. Spinal anesthesia (SA) has been shown to decrease postoperative complications, improve resource utilization and increase patient satisfaction when compared to general anesthesia (GA) in joint arthroplasty [3], [4], [5], [6], [7], [8], [9], [10], [11]. Despite increasing evidence demonstrating benefits of regional over general [12], [13], [14], [15], less than 25% of patients undergoing TKA receive SA [7].

The choice of anesthesia for a TKA may be influenced by multiple factors. Some of these factors are clinically guided, such as comorbidities, coagulation status, and BMI. Patients are often not very familiar with the different anesthetic options available to them. It is the responsibility of the anesthesiologist to present anesthetic options, and carefully explain the risks and/or benefits of proceeding with one modality over another [16], [17]. In our institution, patients undergoing joints arthroplasty are offered an optional 3 h-long educational session (joints class) about their upcoming surgery. The class includes information about different anesthesia options, pros and cons of each technique.

The aim of this study is to test the hypothesis that proper advanced preoperative education about the advantage of SA over GA in the setting of TKA is associated with a higher number of patients choosing a regional anesthetic.

Section snippets

Methods and statistics

This study was approved by the IRB of the University of Pennsylvania, Perelman School of Medicine.

Results

1010 patients were identified to have unilateral primary TKA (Fig. 1). The rate of joint class attendance was 31%. 48% of patients received spinal anesthesia for their surgery. Patient characteristics are listed in (Table 1). Patients attending the joint class were significantly older than those who did not attend (p = 0.002). Attendance of the class was different among patients based on the attending surgeon (p = 0.001). Characteristics of patients attending the joint class are listed in (Table 2).

Discussion

Attendance of the preoperative joint education class was associated with higher odds of choosing spinal over general anesthesia. Patients treated by certain surgeons were also more likely to receive spinal anesthesia. Patients’ age, ASA status, insurance carrier, and regional training of the individual anesthesiologist were not associated with an increase in the rate of spinal anesthesia.

Preoperative patient education is certainly not a new concept and has been an increasingly studied topic.

Funding

This study was funded by Education and Development Fund, Department of Anesthesiology and Critical Care, University of Pennsylvania.

Authors’ contributions

Nabil M. Elkassabany helped design the study, conduct the study, and analyze the data. Nabil M. Elkassabany has seen the original study data, reviewed the analysis of the data, approved the final manuscript, and is the author responsible for archiving the study files.

Daniel Abraham helped conduct the study and write the manuscript. Daniel Abraham has seen the original study data, reviewed the analysis of the data, and approved the final manuscript.

Stephanie Huang helped conduct the study and

Conflicts of interest

The authors declared that no conflicts of interest.

References (25)

  • A.J. Macfarlane et al.

    Does regional anesthesia improve outcome after total knee arthroplasty?

    Clin. Orthop. Relat. Res.

    (2009)
  • S.G. Memtsoudis et al.

    Perioperative comparative effectiveness of anesthetic technique in orthopedic patients

    Anesthesiology

    (2013)
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    Information for LWW regarding depositing manuscript into PubMed Central: This paper does not need to be deposited in PubMed Central. This manuscript describes human research. IRB contact information: IRB7, University of Pennsylvania, School of Medicine. This study was conducted with approval of the IRB. This report describes a retrospective cohort study. This manuscript was not screened for plagiarism.

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