Optimizing perioperative management of total joint arthroplasty

Rebecca L Johnson; Sandra L Kopp

doi:10.1016/j.anclin.2014.08.006

Optimizing perioperative management of total joint arthroplasty

Anesthesiol Clin. 2014 Dec;32(4):865-80. doi: 10.1016/j.anclin.2014.08.006. Epub 2014 Nov 25.

Authors

Rebecca L Johnson¹, Sandra L Kopp²

Affiliations

¹ Department of Anesthesiology, College of Medicine, Mayo Clinic, 200 First Street, Southwest, Rochester, MN 55905, USA. Electronic address: johnson.rebecca1@mayo.edu.
² Department of Anesthesiology, College of Medicine, Mayo Clinic, 200 First Street, Southwest, Rochester, MN 55905, USA.

PMID: 25453667
DOI: 10.1016/j.anclin.2014.08.006

Abstract

Clinical pathways for total joint arthroplasty have been shown to reduce costs and significantly impact perioperative outcomes mainly through reducing provider variability. Effective clinical pathways link evidence to individual practice and balance costs with local experience, outcomes, and access to resources for responsible perioperative management. Common components of clinical pathways with major impact on perioperative outcomes are: 1) implementing pathways designed to include multimodal analgesia with regional anesthesia, 2) use of tranexamic acid to reduce blood loss, and 3) preconditioning followed by participation in early, accelerated rehabilitation programs to prevent postoperative complications related to immobility.

Keywords: Anesthesia; Arthroplasty; Clinical pathways; Conduction; Critical pathways; Perioperative care; Replacement.

Publication types

Research Support, Non-U.S. Gov't
Review

MeSH terms

Anesthesia / methods*
Arthroplasty, Replacement / methods*
Arthroplasty, Replacement, Hip / methods
Arthroplasty, Replacement, Knee / methods
Humans
Perioperative Care / methods*