title: Clinical pathway management of total knee arthroplasty.
abstract: Using a retrospective cohort study design, the authors examined complications, readmissions, morbidity and mortality, and function scores in two groups of patients attended by the same surgeon for the year before and the year after the implementation of an outcomes management program with clinical pathways for patients undergoing total knee arthroplasty at an academic health center. The effectiveness of the pathway constantly was adjusted using variance analysis and continuous quality improvement techniques. This program reduced the length of stay by 57% from a premanagement value of 10.9 +/- 5.4 days in 1994 (Group 1) to 4.7 +/- 1.4 days in 1996 (Group 2). Hospital costs (based on an inflation adjusted cost to charge ratio) for all total knees were reduced 11% from $13,328 +/- $3905 in 1994 to $11,862 +/- $4763 in 1996. Preoperative and postoperative knee scores were 41.1 +/- 16.3 and 84.2 +/- 16.0 for Group 1 and 42.5 +/- 13.0 and 87.0 +/- 10.4 for Group 2, respectively. There was no statistically significant difference between the preoperative or the postoperative knee scores of Groups 1 and 2. The application of clinical pathways, variance analysis, and continuous quality improvement toward the treatment of patients who had total knee arthroplasty at an academic health center resulted in significant savings in length of stay without adversely affecting overall outcome.
authors.affiliation: Department of Orthopaedics, University of Texas Health Science Center at San Antonio 78284-7774, USA.
authors.forename: J D
authors.initials: JD
authors.lastname: Mabrey
authors.forename: J S
authors.initials: JS
authors.lastname: Toohey
authors.forename: D A
authors.initials: DA
authors.lastname: Armstrong
authors.forename: L
authors.initials: L
authors.lastname: Lavery
authors.forename: L A
authors.initials: LA
authors.lastname: Wammack
mesh_terms: D000046:Academic Medical Centers / Q000191:economics / Q000706:statistics & numerical data; D000704:Analysis of Variance; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects / Q000191:economics / Q000401:mortality / Q000706:statistics & numerical data; D015331:Cohort Studies; D019091:Critical Pathways; D005260:Female; D005500:Follow-Up Studies; D017722:Hospital Charges; D017721:Hospital Costs; D006801:Humans; D007250:Inflation, Economic; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010351:Patient Discharge; D010359:Patient Readmission; D016059:Range of Motion, Articular; D012189:Retrospective Studies; D013781:Texas / Q000453:epidemiology; D017749:Total Quality Management