title: Are critical pathways and implant standardization programs effective in reducing costs in total knee replacement operations?
abstract: BACKGROUND
  Total knee replacement (TKR) operation is one of the most effective procedures, both clinically and in terms of cost. Because of increased volume and cost for this procedure during the past 3 decades, TKRs are often targeted for cost reduction. The purpose of this study was to evaluate the efficacy of two cost reducing methodologies, establishment of critical clinical pathways, and standardization of implant costs.
  
  
  METHODS
  Ninety patients (90 knees) were randomly selected from a population undergoing primary TKR during a 2-year period at a tertiary teaching hospital. Patients were assigned to three groups that corresponded to different strategies implemented during the evolution of the joint-replacement program. Medical records were reviewed for type of anesthesia, operative time, length of stay, and any perioperative complications. Financial information for each patient was compared among the three groups.
  
  
  RESULTS
  Data analysis demonstrated that the institution of a critical pathway significantly shortened length of hospital stay and was effective in reducing the hospital costs by 18% (p < 0.05). In addition, standardization of surgical techniques under the care of a single surgeon substantially reduced the operative time. Selection of implants from a single vendor did not have any substantial effect in additionally reducing the costs.
  
  
  CONCLUSIONS
  Standardized postoperative management protocols and critical clinical pathways can reduce costs and operative time. Future efforts must focus on lowering the costs of the prostheses, particularly with competitive bidding or capitation of prostheses costs. Although a single-vendor approach was not effective in this study, it is possible that a cost reduction could have been realized if more TKRs were performed, because the pricing contract was based on projected volume of TKRs to be done by the hospital.
authors.affiliation: Department of Orthopedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX 75390-8883, USA.
authors.forename: David M
authors.initials: DM
authors.lastname: Ho
authors.forename: Michael H
authors.initials: MH
authors.lastname: Huo
mesh_terms: D000368:Aged; D001172:Arthritis, Rheumatoid / Q000601:surgery*; D019645:Arthroplasty, Replacement, Knee / Q000191:economics* / Q000592:standards*; D015331:Cohort Studies; D003363:Cost Control; D019091:Critical Pathways / Q000191:economics*; D005260:Female; D017721:Hospital Costs; D006801:Humans; D008297:Male; D020370:Osteoarthritis, Knee / Q000601:surgery*; D015397:Program Evaluation; D012015:Reference Standards; D016896:Treatment Outcome