Background & Aims
In the U.S.A. alone, over 1.2 million Medicare beneficiaries will annually undergo total knee arthroplasty (TKA) by 2040 [1], a surgery associated with high postoperative pain [2-4]. After undergoing a TKA, up to 20% of older patients experience a complication [5], which often adds to their pain and influences their recovery. In our study assessing the impact of a behavioral intervention on postoperative pain and function among older adults undergoing TKA, we hypothesized participants experiencing a complicated recovery may benefit from an additional dose of the intervention. However, without a standard definition and mutual understanding [6-8], incongruent perceptions between patients and researchers of what constitutes a complication influencing their recovery surfaced. Thus, our aim is to describe details of this incongruity and implications for our randomized controlled trial in an older adult surgical population where pain and function were the primary outcome measures.
Methods
Older adults undergoing a TKA at six study sites were recruited and randomized to receive Acceptance and Commitment Therapy (ACT) or Attention Control, both consisting of attending a one-day, small group workshop before surgery, plus a 30-minute, individualized “booster” session with a study psychologist 2-4 weeks after surgery. Participants were assigned a second “booster” session if 1) a complication was reported by the patient via survey at 6-weeks postoperatively, 2) recommended by a study psychologist after conducting the first “booster” session, or 3) research staff learned of a complication during participants’ involvement in the study. Complications from all sources were compiled and classified by severity using the Clavien-Dindo (CD) [9-11] Classification of Surgical Complications. Concordance among participants and study staff in reporting complications was then assessed using descriptive statistics, as well as qualitative analysis of participant written responses.
Results
Preliminary results indicate 46% (154/336) of all participants experienced a complication (patient-reported or found by research nurse in electronic health record) within the first 6 weeks of surgery. Notably, 19% (65/336) of all participants had a serious complication (e.g. intraoperative fracture, reoperation [for infection], death), defined as CD grade III or higher. Further, of that 19%, less than half of the participants self-reported these serious complications when surveyed – even in cases where participants underwent reoperation and/or revision surgery. Conversely, of the complications reported by participants, 56% (39/70) were CD I or II and thus, not serious from a healthcare perspective, but indicated by participants to have impacted their recovery or caused them stress. Of those, 69% (27/39) were CD grade I and primarily consisted of high pain in the surgical knee and/or other painful musculoskeletal conditions.
Conclusions
Patients rely on those in healthcare to advocate on their behalf and find answers to questions that impact their health goals and well-being [12]. How patients define a postoperative complication can differ dramatically from clinicians’. This mismatch has implications not only for the provision of interventions aimed at improving postoperative pain and function, but also for clinical care. Additionally, there is a lack of an agreed upon postoperative complication definition or instruments to comprehensively assess complications incurred by older patients following TKA. Combined, the science of improving pain and function after TKA is inhibited.
References
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Presenting Author
Jennie Embree
Poster Authors
Andrea Strayer
PhD
University of Iowa College of Nursing
Lead Author
Jennie Embree
University of Iowa
Lead Author
cynthia doyle
University of Iowa College of Nursing
Lead Author
Paula Goetzinger
BSN
College of Nursing, University of Iowa
Lead Author
Lauren Garvin
University of Iowa
Lead Author
Katherine Hadlandsmyth
University of Iowa
Lead Author
Wen Liu
University of Iowa
Lead Author
Lilian Dindo
Baylor College of Medicine
Lead Author
Barbara Rakel
University of Iowa
Lead Author
Topics
- Pain in Special Populations: Elderly