CLINICAL PATHWAY MANAGEMENT OF TOTAL KNEE ARTHROPLASTY

Using a retrospective cohort study design, the authors examined compli cations, readmissions, morbidity and mortality, and function scores in two groups of patients attended by the same surgeon for the year befo re and the year after the implementation of an outcomes management pro gram with clinical pathways for patients undergoing total knee arthrop lasty at an academic health center. The effectiveness of the pathway c onstantly 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 inflat ion adjusted cost to charge ratio) for all total knees were reduced 11 % from $13,328 +/- $3905 in 1994 to $11,862 +/- $4763 in 1996, Preoper ative 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, respec tively. There was no statistically significant difference between the preoperative or the postoperative knee scores of Groups 1 and 2, The a pplication of clinical pathways, variance analysis, and continuous qua lity improvement toward the treatment of patients who had total knee a rthroplasty at an academic health center resulted in significant savin gs in length of stay without adversely affecting overall outcome.