European Journal of Cardiovascular Medicine

Orthopedic procedures, including joint replacements and spinal surgeries, are increasingly common, particularly in the aging population. These surgeries carry significant risks of perioperative complications such as venous thromboembolism, blood loss, cardiac events, and infections[1]. Anesthesia care, traditionally focused on intraoperative management, is now evolving to a more holistic perioperative model. This includes preoperative optimization, intraoperative monitoring, and aggressive postoperative pain control[2,3].

This study investigates how structured perioperative anesthesia protocols impact clinical outcomes in orthopedic surgery patients, focusing on complications, length of stay, pain control, and patient satisfaction.

Study Design:
Prospective observational study conducted at a tertiary care hospital.

Sample Size:
200 patients undergoing elective orthopedic surgeries (total knee replacement, total hip replacement, spine surgery).

Groups:

• Group A (n=100): Received structured perioperative anesthesia care
• Group B (n=100): Received routine perioperative management

Inclusion Criteria:

• Age ≥18 years
• ASA Grade I–III
• Scheduled for major orthopedic surgery

Exclusion Criteria:

• Emergency surgeries
• Patients with ASA Grade IV and above
• Refusal to participate

Perioperative Care Protocol (Group A):

1. Preoperative:
• Anesthesia consultation
• Optimization of comorbidities
• Nutritional and psychological counseling
2. Intraoperative:
• Goal-directed fluid therapy
• Temperature and hemodynamic monitoring
• Multimodal analgesia with regional blocks
3. Postoperative:
• Regular pain scoring
• PCA or regional catheter pain relief
• Early mobilization and thromboprophylaxis

Data Collected:

• Postoperative complications
• Pain scores (Visual Analog Scale)
• Length of hospital stay
• Patient satisfaction (Likert scale)

Statistical Analysis:
Data were analyzed using SPSS v26. Chi-square and t-tests were used to compare categorical and continuous variables, respectively. A p-value of <0.05 was considered significant.

In total, 200 patients were enrolled, with 100 in the structured care group (Group A) and 100 in the routine care group (Group B). Demographics and types of surgeries performed were similar in both groups (p > 0.05), ensuring homogeneity.

1. Postoperative Complications

Postoperative complications were significantly lower in Group A compared to Group B (15% vs. 28%, p = 0.014). The most common complications observed were:

• Surgical site infections: 3 in Group A vs. 8 in Group B
• Delirium: 2 vs. 5
• Venous thromboembolism: 4 vs. 6
• Pulmonary complications (e.g., atelectasis, pneumonia): 6 vs. 12

This reduction in complications reflects the impact of preoperative optimization, goal-directed intraoperative care, and early mobilization protocols.

2. Pain Scores

Pain was assessed using the Visual Analog Scale (VAS) at 24, 48, and 72 hours postoperatively.

• VAS at 24 hours:
• Group A: 2.9 ± 1.1
• Group B: 4.7 ± 1.4 (p< 0.001)
• VAS at 48 hours:
• Group A: 2.2 ± 1.0
• Group B: 3.6 ± 1.3 (p< 0.001)

Patients in Group A received multimodal analgesia, including regional techniques (e.g., femoral nerve block for knee arthroplasty, ESP blocks for spine surgery), leading to superior pain control.

3. Length of Hospital Stay

The mean hospital stay was significantly shorter in Group A (3.2 ± 1.3 days) compared to Group B (5.1 ± 1.8 days, p = 0.002). Early mobilization, reduced opioid use, and fewer complications contributed to faster discharge in the structured care group.

4. Patient Satisfaction

Patient satisfaction, assessed using a 5-point Likert scale, was higher in Group A (4.6 ± 0.3) compared to Group B (3.8 ± 0.5, p< 0.001). Areas rated highly included pain control, communication with the anesthesia team, and perceived safety.

Table 1: Group A versus Group B

Complications Observed:

• Delirium
• Surgical site infection
• Thromboembolic events
• Pulmonary complications

This study reinforces the importance of perioperative anesthesia care in improving surgical outcomes for orthopedic patients. A 13% absolute reduction in postoperative complications was observed in the structured care group, aligning with findings by Memtsoudis et al., who demonstrated that anesthesia protocols tailored to patient risk significantly reduced morbidity in orthopedic surgeries [1].

Pain management is critical in postoperative recovery. The use of regional anesthesia and multimodal analgesia in Group A correlates with better VAS scores and reduced opioid consumption, consistent with Apfelbaum et al.’s practice guidelines, which advocate regional techniques for superior pain relief and early mobilization [3].

Shorter hospital stays in Group A can be attributed to fewer complications and better pain control. Kehlet and Wilmore highlighted that enhanced recovery protocols, which include structured anesthesia care, directly lead to reduced hospital length of stay and faster return to function [2].

Improved patient satisfaction in Group A reflects the psychological impact of well-managed pain, reduced side effects, and a sense of perioperative continuity. Ljungqvist et al. also emphasize that patient-reported outcomes and satisfaction should be key metrics in evaluating surgical success [4].

The most striking aspect of this study is how integrated anesthesia care—ranging from preoperative optimization to postoperative monitoring—acts as a cornerstone of enhanced recovery after orthopedic surgery. Fischer et al. report similar trends, suggesting that multidisciplinary involvement, especially by anesthesiologists, ensures better adherence to fast-track pathways and reduces variability in care [6].

Furthermore, the application of goal-directed fluid therapy and temperature maintenance during surgery, key components of intraoperative structured care in Group A, have been associated with improved tissue perfusion, fewer wound infections, and reduced cardiovascular stress, as noted by Thiruvenkatarajan et al. [5].

This study is consistent with global trends toward anesthesia-led enhanced recovery protocols in orthopedic surgery. The role of anesthesiologists has evolved from intraoperative sedationists to perioperative physicians, actively managing patient risks and improving outcomes through comprehensive care planning [9].

Limitations

• The study was single-center, which may limit generalizability.
• Randomization was not performed; however, groups were matched demographically.
• Long-term outcomes such as readmissions and functional recovery were not assessed.

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