A Better Road to Recovery?

Going fully under may not be best option for all hip and knee replacement surgeries

By Mayo Clinic Staff

"I help guide patients based on what I see from my perspective — how well patients recover with one choice of anesthesia versus another," says Rebecca L. Johnson, M.D.

Rebecca L. Johnson, M.D., is a card-carrying Iron Ranger, a native of the northeastern Minnesota region that boasts iron ore, Bob Dylan and an unapologetic blue-collar, close-knit, work-hard-play-hard culture.

Meeting this clinical anesthesiologist at Mayo Clinic in Rochester, Minnesota, is as effortless as chatting with your fishing buddy about the latest catch. In fact, as an avid hunter, fisher and camper, she may tease out a fishing yarn during your medical consultation. (If Dancing with the Stars is more your thing, don't worry. She has a small obsession with TV shows and movies, too.)

Putting patients at ease through common interests is important, Dr. Johnson says, because the window of time for establishing trust is very narrow.

"The morning of surgery is the first time a majority of patients meet their anesthesia provider, which is a huge disadvantage," she says. "It's when you're most vulnerable, many times wearing just a very thin piece of cloth. You're overwhelmed by the experience, asking yourself questions like, Am I going to be safe? Am I going to make it out of this procedure? When am I going to be able to return to work?

"You've likely talked about anesthesia with your surgeon in prior consultations, but in those moments with the anesthesiologist, you need to make a final choice," — be put fully under for the surgery or be lightly sedated.

A pivotal decision

Total hip and knee replacements are among the most common procedures performed at hospitals across the country and account for billions in annual Medicare expenditures. With an aging population and high rates of obesity, the volume of these procedures will only grow in the coming years. However, today there is no solid evidence guiding patients or doctors about which anesthesia choice — sleeping but breathing on your own with spinal anesthesia or going completely under with general anesthesia — is more effective or less costly in the long run.

Many people may think being completely "knocked out" is the easiest route to go, but Dr. Johnson observes that for certain groups spinal anesthesia with light sedation may result in a quicker recovery time and less pain after 30 days.

"I help guide patients based on what I see from my perspective — how well patients recover with one choice of anesthesia versus another," she says.

The Health Care Delivery Scholars Program is helping her develop those observations into concrete evidence for patients and providers. As a scholar in the program, she systematically reviews current literature on anesthesia used for hip and knee replacement surgery and analyzes large data sets from hospitals and insurance companies to understand long-term patient outcomes on a national level.

Dr. Johnson's work is part of Mayo Clinic's larger effort to apply scientific techniques and data to evaluate the quality, safety and value of health care globally. Housed in the Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, the Health Care Delivery Scholars Program trains clinicians through mentorships with the center's leading experts in epidemiology, health care economics, surgical outcomes, data analysis and other research fields.

Dr. Johnson credits mentors in both the Department of Anesthesiology and the Mayo Clinic Kern Center for the Science of Health Care Delivery for seeing her potential to make a difference.

"This opportunity comes with a lot of responsibility, and I take it seriously," she says, armed with an Iron Ranger's grit to get the job done.

Evidence-based, high-quality, high-value care: Your gift makes it possible. Give now.