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Patient Compliance with Total Joint Arthroplasty Preoperative Instructions

Background: Compliance with preoperative guidelines such as medications and body washes are actions a patient can participate in so as to improve outcomes and decrease the risk of adverse events after total joint arthroplasty. The aim of this study was to assess our patients’ compliance with preoperative instructions and guidelines. Proper preoperative compliance might lead to better outcomes in patient safety, care, and overall clinical outcomes of total joint arthroplasty.

Methods: In a prospective observational study, we analyzed patient compliance to a protocolized preoperative regimen that included preoperative warfarin, celecoxib, mupirocin, chlorhexidine body washes, surgical site shaving, and surgical site marking. Consecutive patients undergoing total joint arthroplasty were included. Patients filled out a questionnaire the day of surgery indicating their compliance with the preoperative guidelines. Statistical analysis was completed to calculate confidence intervals of overall compliance and any difference in compliance based on age or gender.

Results: Compliance rates overall were: warfarin 87%, celecoxib 87%, mupirocin 84%, chlorhexidine 98%, shaving 91% and site marking 99%. Based on age sub-group analysis, there was no significant difference in compliance based on age or gender, and compliance did not fall below 82% in any category.

Discussion: The currently used protocol of patient preoperative preparation achieves rates of compliance equivalent if not better to other studies. The lowest overall percentage of compliance was 84% in the mupirocin category. Therefore, the current regimen, while not perfect, is not inferior to other methods of improving patient compliance, and leaves a blueprint for other total joint arthroplasty surgeons to build off.


Ran Schwarzkopf

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