Protocols for Management of Underserved Patients Undergoing Arthroplasty: A National Survey of Safety Net Hospitals

Abstract

Background: Although it has been shown that perioperative protocols enhance arthroplasty care and safety, it is<br />not known how prevalent their use is in safety net hospitals, which operate with a mandate to treat the poor and<br />underserved. Understanding the elements currently included in standard perioperative arthroplasty protocols at various<br />institutions may help guide future interventions and policy aimed at improving underserved patients' outcomes.<br />Methods: In this cross-sectional study, safety net hospitals were asked to complete a survey over the phone, via<br />email or in person regarding existence and elements of perioperative management protocols for total hip arthroplasty<br />(THA) and total knee arthroplasty (TKA). Implementation barriers were also addressed. Specifically, survey questions<br />sought to determine the total yearly number of arthroplasty procedures performed at each institution and better<br />understand, among other elements, the following: presence of preoperative pain management protocols, inpatient<br />care pathways, use of social workers and involvement of physical therapy services. Descriptive statistics were<br />calculated and reported.<br />Results: Over 90% of safety net hospitals performing arthroplasty utilized regional anesthetic techniques, inpatient<br />clinical care pathways and inpatient physical therapy. However, 16.7%, 20.0%, 23.3% and 73% lacked social services,<br />anesthesia preoperative clinics, inpatient pain management protocols and preoperative sobriety pathways, respectively.<br />Conclusion: Barriers to receiving arthroplasty care included lack of qualified surgical personnel and concerns about<br />surgical risk in vulnerable patient populations. These findings suggest that further effort is warranted to expand and<br />improve arthroplasty care for the underserved to ensure safety and high quality outcomes.