Innovative Hospital: Hospital for Special Surgery

In this series of hospital award winners, we're celebrating medical institutions that employ fresh and advanced approaches to patient care.

After 10 years of living with knee pain and one painful two-mile walk in February weather in Pittsburgh, PA, Nancy Hulton wanted her mobility back to travel and enjoy activities with her husband. She decided it was time to speak with a doctor about knee replacement surgery, so she began looking for a surgeon.

When Hulton chose Elizabeth Gausden, MD, MPH, at the Hospital for Special Surgery (HSS), she didn’t know Dr. Gausden worked with anesthesiologist Stephanie Cheng, MD, who is also a board-certified medical acupuncturist. On the day of surgery, Dr. Cheng met with Hulton and explained how she would perform acupuncture during Hulton’s surgery.

“I was actually kind of interested and excited to see how that would work, and they do it all while you’re in the surgery, so you don’t feel anything,” says Hulton.  

Dr. Cheng performs intraoperative electro-auricular acupuncture, which she said is based on auricular trauma protocol (ATP), an acupuncture practice that was originally used in the military to treat post-traumatic stress disorder. She explained that the acupuncture points she hits from ATP have to do with fear, memory, anxiety, and how the body is feeling overall. Dr. Cheng then added points for anti-inflammation and pain.

After patients are sedated, she places eight needles in the ear (away from surgical sites). Dr. Cheng said she uses the ear because the whole body is represented on the hand, ear, and scalp in acupuncture, and she knows the ear points well and can do her work without interrupting the flow of surgery. 

She also adds electricity to boost the acupuncture benefits. “About 99% of patients get the electricity added, and it really juices it up for the one hour the needles stay in,” Dr. Cheng explains.

Her program at HSS began in October 2018, and she has since seen about 1,000 patients. The program is unique because acupuncture isn’t commonly done in the operating room in the United States. Dr. Cheng said she designed her program with the notion that her office is the operating room. As an anesthesiologist, she sees someone when they come into the operating room and then when they’re asleep. So, she said her objective with acupuncture is to do what she can to help with recovery.

The patients and surgeons who work with her say they notice a difference in the recovery room, and Hulton is no exception.

“When I got up from surgery, I didn’t have any pain. I was able to walk. I went home that day,” says Hulton. She also said she took less oxycodone than what she would normally take for pain and was able to transition to Tylenol after three days.

When Hulton scheduled her second knee surgery, Dr. Cheng wasn’t the anesthesiologist working with her surgeon that day. She said there was a big difference in the way she experienced recovery, despite her doctor explaining that the surgeries were extremely similar. 

“When I woke up from the surgery, I was in pain immediately,” she says. “The oxycodone didn’t even work.” Hulton also said it took more oxycodone to manage the pain than after her first surgery.

While there isn’t enough research to explain exactly how and why acupuncture works during surgery, Dr. Cheng and her colleagues at HHS are studying it.

Dr. Cheng conducted a study on the ability of acupuncture to reduce pain and opioid usage for people getting total knee replacement surgery. The study looked at 41 patients at the Hospital for Special Surgery and found that 65% of patients who received acupuncture used fewer opioid pills in the 30 days after surgery compared with 9% of patients outside of the study who did not receive acupuncture. 

Michael Ast, MD, adult reconstruction and joint replacement chief medical innovation officer vice-chair at HSS Innovation Institute, has been working with Dr. Cheng for about three and a half years and has observed differences in patient behavior in the recovery room with and without acupuncture. In his 10 years of performing hip and knee replacement surgery, Dr. Ast says he has never seen patients look as good after the operation as his acupuncture patients do. 

Typically most patients, according to Dr. Ast, are sleeping, feeling nauseated, or not looking so great in the recovery room. “The acupuncture patients are sitting up laughing, smiling, joking with me,” he says. “It looks like they’ve never had surgery, and I have never found another way to explain it.”

As for Hulton, she said she would definitely ask for acupuncture if she needed surgery again. “I was just much more comfortable and much more relaxed after the first surgery, and the second surgery was so much more pain,” she says.

This article was fact checked by Morgan Mullings.