Five-year follow-up to assess long-term sustainability of changing clinical practice regarding anesthesia and regional analgesia for lower extremity arthroplasty
- Author:
Mallika TAMBOLI
1
;
Jody C. LENG
;
Oluwatobi O. HUNTER
;
Alex KOU
;
Seshadri C. MUDUMBAI
;
Stavros G. MEMTSOUDIS
;
Tessa L. WALTERS
;
Gregory Milo LOCHBAUM
;
Edward R. MARIANO
Author Information
- Publication Type:Clinical Research Article
- From:Korean Journal of Anesthesiology 2020;73(5):401-407
- CountryRepublic of Korea
-
Abstract:
Background:Long-term and sustainable clinical practice changes in anesthesia procedures have not previously been reported. Therefore, we performed a 5-year audit following implementation of a clinical pathway change favoring spinal anesthesia for total knee arthroplasty (TKA). We similarly evaluated a parallel cohort of patients undergoing total hip arthroplasty (THA), who did not undergo a clinical pathway change, and studied utilization rates of continuous peripheral nerve block (CPNB).
Methods:We identified all primary unilateral TKA and THA cases completed from January 2013 through December 2018, thereby including clinical pathway change data from one-year pre-implementation to 5-years post-implementation. Our primary outcome was the overall application rate of spinal anesthesia. Secondary outcomes included CPNB utilization rate, 30-day postoperative complications, and resource utilization variables such as hospital readmission, emergency department visits, and blood transfusions.
Results:The sample included 1,859 cases, consisting of 1,250 TKAs and 609 THAs. During the initial year post-implementation, 174/221 (78.7%) TKAs received spinal anesthesia compared to 23/186 (12.4%) cases the year before implementation (P < 0.001). During the following 4-year period, 647/843 (77.2%) TKAs received spinal anesthesia (P = 0.532 vs. year 1). The number of THA cases receiving spinal anesthesia the year after implementation was 78/124 (62.9%), compared to 48/116 (41.4%) pre-implementation (P = 0.001); however, the rate decreased over the following 4-year period to 193/369 (52.3%) (P = 0.040 vs. year 1). CPNB use was high in both groups, and there were no differences in 30-day postoperative complications, hospital readmission, emergency department visits, or blood transfusions.
Conclusions:A clinical pathway change promoting spinal anesthesia for TKA can be effectively implemented and sustained over a 5-year period.
