Incidence and Impact of Sensory Recall in Patients Undergoing Total Joint Arthroplasty

Abstract

Introduction Recall of auditory and physical sensations during hip and knee arthroplasty surgery is inadequately studied. We investigated rates of sensory recall, impact on satisfaction, and risk factors. Methods We surveyed 164 consecutive patients after primary or revision arthroplasty about sensory recall and its impact on satisfaction (improved, worsened, or no effect), without exclusions. Three surgeons and 25 anesthesiologists in an academic university hospital setting provided care. Demographic data (age, gender, BMI, comorbidities, ASA class), type of anesthesia, intravenous fentanyl and midazolam doses, pre-operative diagnosis, type of surgery, anesthesia duration, and surgery time (morning vs afternoon case) were analyzed. Pearson’s correlation coefficient was calculated for each variable. A binary logistic regression model was used to identify risk factors for sensory recall. Results 147 patients (89.6%) received spinal anesthesia. No patients receiving general anesthesia had recall. Twenty-three patients (14.0% of the total, 15.6% of neuraxial anesthesia patients) had sensory recall after surgery: 19 (11.6%) auditory, 2 (1.2%) physical, and 2 (1.2%) both. There was a correlation between spinal anesthesia and sensory recall, r = 0.163, p = 0.037. On logistic regression, decreasing age (p=0.032, 95% CI, 0.894–0.995) and less midazolam (p = 0.009, 95% CI, 0.283–0.832) were significant risk factors for sensory recall. Seventeen (73.9%) reported no impact on satisfaction (14 auditory, 2 physical, 1 both), while two (8.7%) reported worse satisfaction (1 auditory, 1 both) and four (17.4%) reported improved satisfaction (all auditory). Conclusion We found a 14.0% rate of sensory recall. Spinal anesthesia, decreasing age, and lower benzodiazepine administration were associated with sensory recall. Sensory recall has a minimal effect on patient satisfaction, although some were still affected. Although we focused on instrument sounds, our high rate of sensory recall serves as a reminder to also be mindful of conversations in the operating room. Level of Evidence Level II