title: The effect of a perioperative clinical pathway for knee replacement surgery on hospital costs.
abstract: Clinical pathways are being introduced by hospitals to reduce costs and control unnecessary variation in care. We studied 766 inpatients to measure the impact of a perioperative clinical pathway for patients undergoing knee replacement surgery on hospital costs. One hundred twenty patients underwent knee replacement surgery before the development of a perioperative clinical pathway, and 63 patients underwent knee replacement surgery after pathway implementation. As control groups, we contemporaneously studied 332 patients undergoing radical prostatectomy (no clinical pathway in place for these patients) and 251 patients undergoing hip replacement surgery without a clinical pathway (no clinical pathway and same surgeons as patients having knee replacement surgery). Total hospitalization costs (not charges), excluding professional fees, were computed for all patients. Mean (+/-SD) hospital costs for knee replacement surgery decreased from $21,709 +/- $5985 to $17,618 +/- $3152 after implementation of the clinical pathway. The percent decrease in hospitalization costs was 1.56-fold greater (95% confidence interval 1.02-2.28) in the knee replacement patients than in the radical prostatectomy patients and 2.02-fold greater (95% confidence interval 1.13-5.22) than in the hip replacement patients. If patient outcomes (e.g., patient satisfaction) remain constant with clinical pathways, clinical pathways may be a useful tool for incremental improvements in the cost of perioperative care.
  
  
  CONCLUSIONS
  Doctors and nurses can proactively organize and record the elements of hospital care results in a clinical pathway, also known as "care pathways" or "critical pathways." We found that implementing a clinical pathway for patients undergoing knee replacement surgery reduced the hospitalization costs of this surgery.
authors.affiliation: Department of Anesthesia, Stanford University Medical Center, California 94305-5115, USA. macario_a@hosp.stanford.edu
authors.forename: A
authors.initials: A
authors.lastname: Macario
authors.forename: M
authors.initials: M
authors.lastname: Horne
authors.forename: S
authors.initials: S
authors.lastname: Goodman
authors.forename: T
authors.initials: T
authors.lastname: Vitez
authors.forename: F
authors.initials: F
authors.lastname: Dexter
authors.forename: R
authors.initials: R
authors.lastname: Heinen
authors.forename: B
authors.initials: B
authors.lastname: Brown
mesh_terms: D000328:Adult; D000368:Aged; D019645:Arthroplasty, Replacement, Knee / Q000191:economics*; D019091:Critical Pathways; D005260:Female; D017721:Hospital Costs; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies