Background: Although it has been shown that perioperative protocols enhance arthroplasty care and safety, it is
not known how prevalent their use is in safety net hospitals, which operate with a mandate to treat the poor and
underserved. Understanding the elements currently included in standard perioperative arthroplasty protocols at various
institutions 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, via
email 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 questions
sought to determine the total yearly number of arthroplasty procedures performed at each institution and better
understand, among other elements, the following: presence of preoperative pain management protocols, inpatient
care pathways, use of social workers and involvement of physical therapy services. Descriptive statistics were
calculated and reported.
Results: Over 90% of safety net hospitals performing arthroplasty utilized regional anesthetic techniques, inpatient
clinical 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 about
surgical risk in vulnerable patient populations. These findings suggest that further effort is warranted to expand and
improve arthroplasty care for the underserved to ensure safety and high quality outcomes.