A patient's mental health plays a role in how much pain he experiences following knee and hip replacement surgery, according to a pair of studies presented last week at the annual meeting of the American Academy of Orthopaedic Surgeons in San Francisco.

In one study, researchers surveyed 97 patients who were about to undergo total knee arthroplasty to assess their anxiety levels when faced with stressful events such as surgery, their typical levels of anxiety and their potential for "catastrophizing" - an extreme response to stress that manifests in rumination, magnification and perceived helplessness.

After measuring pain scores in patients for 7 days following their surgeries, the researchers discovered that catastrophizing did not influence how much pain patients experienced. However, men with anxiety traits experienced high levels of post-op pain that extended their hospital stays during recovery. Anxiety was not an accurate predictor of post-op pain in women, according to the study, which notes women experienced higher post-op pain than men and were generally less satisfied with the level of pain control they received.

In a second report, researchers examined approximately 1,650 patients who took antidepressants up to 3 years before undergoing hip replacement surgery. Surveys given to patients before and 1 year after procedures revealed that patients who took antidepressants reported greater pain and dissatisfaction with their surgeries' results.

Daniel Cook

Patients undergoing total knee replacement on an outpatient basis face a much higher mortality risk, and are more likely to be readmitted within 90 days in comparison to patients with a 3- to 4-day hospital stay, according to a study presented at the American Academy of Orthopaedic Surgeons' annual meeting last week.

In a study of 108,000 Medicare beneficiaries who underwent the procedure, researchers found that the hazard ratio for 90-day mortality in outpatients was 1.66 relative to patients staying in the hospital for the standard 3 or 4 days after the procedure. Outpatients were 1.57 times more likely to be readmitted within 90 days, reported study author Scott Lovald, PhD, MPH, of Philadelphia-based research firm Exponent. Moreover, rates of subsequent revision surgery were nearly doubled in patients having 1-day hospital stays, compared with the standard 3 or 4 days, according to Dr. Lovald.

The study's authors recommend that hospitals choosing to implement shorter-stay protocols for total knee replacement patients should do so gradually and only with appropriate and sufficient capabilities, to ensure capacity and avoid complications.

Mark McGraw

The U.S. Department of Health & Human Services has announced plans to survey healthcare facilities' compliance with HIPAA regulations through 2012. How secure is your patients' private data? Do you know what to do if it falls to unauthorized access?

In "Make Protecting Patient Privacy a Priority," which appears in the February issue of Outpatient Surgery Magazine, medical malpractice and professional liability attorney Michael J. Sacopulos, JD, explains what constitutes a security breach and details the steps required by HIPAA and the HITECH Act in the event that such a breach occurs.

David Bernard

Remember Kristen Parker, the surgical tech infected with hepatitis C who stole vials of fentanyl that were left unlocked and unattended, injected herself, then refilled the used syringes with saline solution? One of the patients that Ms. Parker allegedly infected with hepatitis C is suing a Colorado anesthesiologist for not locking up the fentanyl that Ms. Pakrer stole.

The anesthesiologist said in court records that her standard practice was to draw up medications before a surgery, then hide the drugs in unlocked carts underneath intubation tubes or other equipment. She said that when she left the room to accompany post-operative patients, she trusted personnel like Ms. Parker.

What's your take? Should drawn-up syringes and vials be either under lock and key at all times or in the immediate possession of the anesthesia provider? Tell us in this week's InstaPoll.

Last week we asked if some of the pre-op lab tests your facility orders were unnecessary. The results, based on 336 responses: