Clinical pathway management of total knee arthroplasty

Jay D. Mabrey, John S. Toohey, David G Armstrong, Lawrence Lavery, Lisa A. Wammack

Research output: Contribution to journalArticle

85 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)125-133
Number of pages9
JournalClinical Orthopaedics and Related Research
Issue number345
StatePublished - 1997
Externally publishedYes

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Knee Replacement Arthroplasties
Critical Pathways
Knee
Quality Improvement
Length of Stay
Analysis of Variance
Hospital Costs
Economic Inflation
Health
Cohort Studies
Retrospective Studies
Morbidity
Costs and Cost Analysis
Mortality
Therapeutics

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine

Cite this

Mabrey, J. D., Toohey, J. S., Armstrong, D. G., Lavery, L., & Wammack, L. A. (1997). Clinical pathway management of total knee arthroplasty. Clinical Orthopaedics and Related Research, (345), 125-133.

Clinical pathway management of total knee arthroplasty. / Mabrey, Jay D.; Toohey, John S.; Armstrong, David G; Lavery, Lawrence; Wammack, Lisa A.

In: Clinical Orthopaedics and Related Research, No. 345, 1997, p. 125-133.

Research output: Contribution to journalArticle

Mabrey, JD, Toohey, JS, Armstrong, DG, Lavery, L & Wammack, LA 1997, 'Clinical pathway management of total knee arthroplasty', Clinical Orthopaedics and Related Research, no. 345, pp. 125-133.
Mabrey, Jay D. ; Toohey, John S. ; Armstrong, David G ; Lavery, Lawrence ; Wammack, Lisa A. / Clinical pathway management of total knee arthroplasty. In: Clinical Orthopaedics and Related Research. 1997 ; No. 345. pp. 125-133.
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