scholarly journals Operating room time comparison between spinal and general anesthesia in total knee arthroplasty: an institutional review

2021 ◽  
Author(s):  
Kelly Chandler ◽  
Roshan Jacob ◽  
George E. Kuntz IV ◽  
Mackenzie Sowers ◽  
Gerald McGwin ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
General Anesthesia ◽  
Operating Room ◽  
Knee Arthroplasty ◽  
Institutional Review ◽  
Total Knee ◽  
Room Time ◽  
Operating Room Time

scholarly journals Spinal versus general anesthesia for patients undergoing outpatient total knee arthroplasty: a national propensity matched analysis of early postoperative outcomes

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Mark C. Kendall ◽  
Alexander D. Cohen ◽  
Stephanie Principe-Marrero ◽  
Peter Sidhom ◽  
Patricia Apruzzese ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Adverse Events ◽  
General Anesthesia ◽  
Knee Arthroplasty ◽  
Anesthetic Management ◽  
Anesthetic Technique ◽  
Anesthetic Techniques ◽  
Short Term ◽  
Knee Replacements ◽  
Total Knee

Abstract Background A comparison of different anesthetic techniques to evaluate short term outcomes has yet to be performed for patients undergoing outpatient knee replacements. The aim of this investigation was to compare short term outcomes of spinal (SA) versus general anesthesia (GA) in patients undergoing outpatient total knee replacements. Methods The ACS NSQIP datasets were queried to extract patients who underwent primary, elective, unilateral total knee arthroplasty (TKA) between 2005 and 2018 performed as an outpatient procedure. The primary outcome was a composite score of serious adverse events (SAE). The primary independent variable was the type of anesthesia (e.g., general vs. spinal). Results A total of 353,970 patients who underwent TKA procedures were identified comprising of 6,339 primary, elective outpatient TKA procedures. Of these, 2,034 patients received GA and 3,540 received SA. A cohort of 1,962 patients who underwent outpatient TKA under GA were propensity matched for covariates with patients who underwent outpatient TKA under SA. SAE rates at 72 h after surgery were not greater in patients receiving GA compared to SA (0.92%, 0.66%, P = 0.369). In contrast, minor adverse events were greater in the GA group compared to SA (2.09%, 0.51%), P < 0.001. The rate of postoperative transfusion was greater in the patients receiving GA. Conclusions The type of anesthetic technique, general or spinal anesthesia does not alter short term SAEs, readmissions and failure to rescue in patients undergoing outpatient TKR surgery. Recognizing the benefits of SA tailored to the anesthetic management may maximize the clinical benefits in this patient population.

scholarly journals Health costs and efficiencies of patient-specific and single-use instrumentation in total knee arthroplasty: a randomised controlled trial

2019 ◽  
Vol 8 (2) ◽  
pp. e000493 ◽  
Author(s):  
Andre Attard ◽  
Gwenllian Fflur Tawy ◽  
Michiel Simons ◽  
Philip Riches ◽  
Philip Rowe ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Blood Loss ◽  
Healthcare Provider ◽  
Operating Room ◽  
Knee Arthroplasty ◽  
Patient Specific ◽  
Potential Cost ◽  
Time Intervals ◽  
Total Knee ◽  
Single Use

AimTo investigate whether patient-specific instrumentation (PSI) and single-use instrumentation (SUI) improve operating room efficiency in terms of time and cost to the healthcare provider over conventional/reusable instrumentation (CVR) when performing total knee arthroplasty (TKA).Patients and methodsPatients requiring TKA were randomised into one of four surgical groups: CVR, CVS (conventional/SUI), PSR (PSI/reusable) and PSS (PSI/SUI). All surgical procedures were video recorded to determine specific surgical time intervals. Other variables reported included the number of instrument trays used, missing equipment, direct instrument costs and the weight of the instruments the staff had to handle. Oxford Knee Score (OKS), estimated blood loss and lengths of hospital stay were also recorded as markers of patient experience.ResultsPSR was significantly quicker in all the recorded time intervals, used less trays, experienced less missing equipment and resulted in lower blood loss and shorter hospital stays. SUI reported significantly slower operating room times and resulted in higher blood loss, but SUI was 88% lighter and 20% cheaper on average when compared with their reusable counterparts. Despite the economic advantages of PSI and SUI, the patients who reported greatest improvements in OKS were those allocated to the CVR group, but no clinically meaningful difference in OKS was found at any time point.ConclusionsPSI and SUI for TKA have the potential of reducing operating room times over conventional, reusable sets. This reduction will benefit theatre personnel ergonomically, while presenting the healthcare provider with potential cost-saving benefits in terms of reduced sterilisation costs and surgical times.

A Comparison of Neuraxial and General Anesthesia for Thirty-Day Postoperative Outcomes in United States Veterans Undergoing Total Knee Arthroplasty

2020 ◽  
Vol 35 (11) ◽  
pp. 3138-3144
Author(s):  
Mohanad Baldawi ◽  
George McKelvey ◽  
Wael Saasouh ◽  
Sameul Perov ◽  
Gamal Mostafa ◽  
...  
Keyword(s):  
United States ◽  
Total Knee Arthroplasty ◽  
General Anesthesia ◽  
Knee Arthroplasty ◽  
Postoperative Outcomes ◽  
Total Knee

Inpatient Falls after Total Knee Arthroplasty

2014 ◽  
Vol 120 (3) ◽  
pp. 551-563 ◽  
Author(s):  
Stavros G. Memtsoudis ◽  
Thomas Danninger ◽  
Rehana Rasul ◽  
Jashvant Poeran ◽  
Philipp Gerner ◽  
...  
Keyword(s):  
Risk Factors ◽  
Total Knee Arthroplasty ◽  
General Anesthesia ◽  
Knee Arthroplasty ◽  
Odds Ratio ◽  
Orthopedic Procedures ◽  
Inpatient Falls ◽  
Total Knee ◽  
Anesthesia Technique

Abstract Background: Much controversy remains on the role of anesthesia technique and peripheral nerve blocks (PNBs) in inpatient falls (IFs) after orthopedic procedures. The aim of the study is to characterize cases of IFs, identify risk factors, and study the role of PNB and anesthesia technique in IF risk in total knee arthroplasty patients. Methods: The authors selected total knee arthroplasty patients from the national Premier Perspective database (Premier Inc., Charlotte, NC; 2006–2010; n = 191,570, &gt;400 acute care hospitals). The primary outcome was IF. Patient- and healthcare system–related characteristics, anesthesia technique, and presence of PNB were determined for IF and non-IF patients. Independent risk factors for IFs were determined by using conventional and multilevel logistic regression. Results: Overall, IF incidence was 1.6% (n = 3,042). Distribution of anesthesia technique was 10.9% neuraxial, 12.9% combined neuraxial/general, and 76.2% general anesthesia. PNB was used in 12.1%. Patients suffering IFs were older (average age, 68.9 vs. 66.3 yr), had higher comorbidity burden (average Deyo index, 0.77 vs. 0.66), and had more major complications, including 30-day mortality (0.8 vs. 0.1%; all P &lt; 0.001). Use of neuraxial anesthesia (IF incidence, 1.3%; n = 280) had lower adjusted odds of IF compared with adjusted odds of IF with the use of general anesthesia alone (IF incidence, 1.6%; n = 2,393): odds ratio, 0.70 (95% CI, 0.56–0.87). PNB was not significantly associated with IF (odds ratio, 0.85 [CI, 0.71–1.03]). Conclusions: This study identifies several risk factors for IF in total knee arthroplasty patients. Contrary to common concerns, no association was found between PNB and IF. Further studies should determine the role of anesthesia practices in the context of fall-prevention programs.

scholarly journals Does the use of Robotic Technology Improve Surgeon Ergonomic Safety during TKA?

10.29007/xjjm ◽  
2019 ◽  
Author(s):  
Laura Scholl ◽  
Emily Hampp ◽  
Vincent Alipit ◽  
Antonia Chen ◽  
Michael Mont ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
High Risk ◽  
Operating Room ◽  
Knee Arthroplasty ◽  
Overuse Injuries ◽  
Robotic Technology ◽  
Robotic Assisted ◽  
Work Related ◽  
Lower Back ◽  
Total Knee

Surgeon physical stress in the operating room is a known potential cause of musculoskeletal overuse injuries, specifically in surgeons who perform total knee arthroplasty (TKA). Injuries have been attributed to ergonomically challenging postures. This study compared surgeon lower back and shoulder posture between manual TKA (MTKA) and robotic assisted TKA (RATKA).Two surgeons performed a total six MTKA and six RATKA on a set of cadaveric knees. Movement and EMG sensors were secured to each surgeon to monitor lower back and shoulder movements, as well as muscle activities. Data was analyzed and activities were assessed as low, medium, or high risk, providing a score between 0-lowest and 16-highest. Risk data was compared between MTKA and RATKA for three separate surgical tasks: 1-bone cut preparation &amp; cutting (MTKA = placement of cutting jigs, bone cutting, RATKA = array placement, bone registration, bone cutting), 2-knee balancing and 3-trialing.Overall, there were more high-risk shoulder than lower back activities in MTKA and RATKA. More high-risk movement and EMG stimulation were measured in the dominant shoulder than the non-dominant. When lower back and shoulder data were combined, highest risk task was bone cut preparation &amp; cutting (MTKA: 13 vs. 6 vs. 6 and RATKA: 11 vs. 8 vs. 6), with a higher risk for MTKA than RATKA.Poor posture can be a potential cause for surgeon work-related injuries. This study evaluated which tasks presented highest risk to surgeon ergonomic safety while performing TKA, and found lower overall ergonomics risk for performing RATKA vs. MTKA. Although this study provides data indicating reduced ergonomic risk with RATKA, additional studies in the operating room need to be performed.

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