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

Background: Although it has been shown that perioperative protocols enhance arthroplasty care and safety, it isnot known how prevalent their use is in safety net hospitals, which operate with a mandate to treat the poor andunderserved. Understanding the elements currently included in standard perioperative arthroplasty protocols at variousinstitutions may help guide future interventions and policy aimed at improving underserved patients’ outcomes.Methods: In this cross-sectional study, safety net hospitals were asked to complete a survey over the phone, viaemail or in person regarding existence and elements of perioperative management protocols for total hip arthroplasty(THA) and total knee arthroplasty (TKA). Implementation barriers were also addressed. Specifically, survey questionssought to determine the total yearly number of arthroplasty procedures performed at each institution and betterunderstand, among other elements, the following: presence of preoperative pain management protocols, inpatientcare pathways, use of social workers and involvement of physical therapy services. Descriptive statistics werecalculated and reported.Results: Over 90% of safety net hospitals performing arthroplasty utilized regional anesthetic techniques, inpatientclinical care pathways and inpatient physical therapy. However, 16.7%, 20.0%, 23.3% and 73% lacked social services,anesthesia preoperative clinics, inpatient pain management protocols and preoperative sobriety pathways, respectively.Conclusion: Barriers to receiving arthroplasty care included lack of qualified surgical personnel and concerns aboutsurgical risk in vulnerable patient populations. These findings suggest that further effort is warranted to expand andimprove arthroplasty care for the underserved to ensure safety and high quality outcomes.