Decreasing medical complications for total knee arthroplasty: effect of critical pathways on outcomes.

BMC Musculoskeletal Disorders
M Elaine HusniJeffrey N Katz

Abstract

Studies on critical pathway use have demonstrated decreased length of stay and cost without compromise in quality of care. However, pathway effectiveness is difficult to determine given methodological flaws, such as small or single center cohorts. We studied the effect of critical pathways on total knee replacement outcomes in a large population-based study. We identified hospitals in four US states that performed total knee replacements. We sent a questionnaire to surgical administrators in these hospitals including items about critical pathway use and hospital characteristics potentially related to outcomes. Patient data were obtained from Medicare claims, including demographics, comorbidities, 90-day postoperative complications and length of hospital stay. The principal outcome measure was the risk of having one or more postoperative complications. Two hundred ninety five hospitals (73%) responded to the questionnaire, with 201 reporting the use of critical pathways. 9,157 Medicare beneficiaries underwent TKR in these hospitals with a mean age of 74 years (+/- 5.8). After adjusting for both patient and hospital related variables, patients in hospitals with pathways were 32% less likely to have a postoperative complication co...Continue Reading

References

Dec 15, 1995·Annals of Internal Medicine·S D PearsonT H Lee
Aug 1, 1997·Nursing Management·C Wallenius
Feb 14, 1998·BMJ : British Medical Journal·H CampbellM Porteous
Aug 26, 1998·The Journal of Nursing Administration·D A BaileyL C Mion
Jan 8, 1999·The Journal of Arthroplasty·D R MauerhanG M Kiebzak
Feb 20, 1999·Archives of Physical Medicine and Rehabilitation·G P ForrestS T Dawodu
Feb 23, 1999·The Medical Journal of Australia·M M DowseyP F Choong
Oct 20, 1999·The American Journal of Medicine·E S HolmboeH M Krumholz
Jun 1, 2000·The Australian and New Zealand Journal of Surgery·S PearsonG J Maddern
Feb 22, 2001·The American Journal of Medicine·S D PearsonT H Lee
Feb 15, 2002·Australian Health Review : a Publication of the Australian Hospital Association·J B Pearson, D J Macintosh
Jan 30, 2003·The Journal of Arthroplasty·Stephen KimJeffrey N Katz
Oct 22, 2003·Annals of Internal Medicine·Katherine S PanageasColin B Begg
Sep 3, 2004·The Journal of Bone and Joint Surgery. American Volume·Jeffrey N KatzElena Losina
Mar 3, 2005·Quality Management in Health Care·Richard J CoffeyPhyllis J Baldwin
Apr 4, 2007·The Journal of Bone and Joint Surgery. American Volume·Steven KurtzMichael Halpern

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Citations

Mar 5, 2013·International Orthopaedics·Stephan Christian MertesVikas Khanduja
Aug 16, 2014·Population Health Management·Bernard P ZeiglerErnest L Carter
Apr 19, 2012·ANZ Journal of Surgery·Conor CrowleyPeter F M Choong
Mar 27, 2015·The Journal of the American Academy of Orthopaedic Surgeons·Matthew J DietzPaul A Manner
Nov 14, 2012·The Journal of Arthroplasty·Lucas B RomineGeorge F Chimento
Jun 16, 2016·Hospital Pharmacy·Rachel HippRobert J Weber
Sep 14, 2018·Journal of the American Academy of Orthopaedic Surgeons. Global Research & Reviews·Robert McCullochOliver Pearce
Jul 2, 2011·Clinical Orthopaedics and Related Research·John S VorhiesJames I Huddleston
Jul 31, 2012·The Journal of Bone and Joint Surgery. British Volume·S AlazzawiR E Field

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