Clinical pathway improves medical practice in total knee arthroplasty

Abstract

Clinical pathways in total knee arthroplasty (TKA) consist of general guidelines, including several topics as early rehabilitation and antibiotic systematization, which are used to improve patient's management, decrease complication rates and enhance clinical outcomes. The primary purpose of this study was to assess whether the use of a clinical pathway for TKA can contribute to reduce LOS and healthcare costs in a private hospital, without an increase in the hospital readmission rate. We also aimed to assess whether care providers adhered to the recommendations mainly antibiotic use and physical therapy. Methods Retrospective cohort study of 485 patients who underwent TKA at private hospital. Patients were analyzed in two groups: Group I (GI), composed by 220 TKA patients, prior to the clinical pathway implementation, and Group 2 (GII), with 265 TKA patients post-clinical pathway. Several outcomes were analyzed: length of hospital stay, time from use of prophylactic antibiotic therapy, readmission within 30 days, physical therapy and costs associated to procedures and hospitalization rates. Results The implementation of the clinical pathway was related with the reduction of the length of hospital stay from 6.3 days to 4.9 days (p = 0.021) without increase in readmissions. The physical therapy on the first postoperative day was most frequent in GII than GI (96.2% vs 78.1%, p < 0.001). Prophylactic ATB 60 minutes prior the surgery was significantly more used in GII than GI (99.2% vs 87.4%, p < 0.001). In addition, ATB suspension within 48 hours was significantly more frequent in GII than GI (84.7% vs. 51.6%, p < 0.001). The cost procedure of TKA showed a reduction of US$1,252.00 in GII when compared with GI (p<0,001).

Qualidade de vida e satisfação de pacientes com idade superior ou inferior a 65 anos submetidos a artroplastia total de joelho

“…18 19 Therefore, it is suggested that some factors may have contributed to the lower rates of dissatisfaction in our population compared with the literature, such as the socioeconomic profile of patients and, mainly, the implementation of a managed protocol for all TKAs performed at the institution after 2013, which standardized the patient care process and led to improvements in medical practice. 20 Similar to the satisfaction rate reported in the present study, there was also no significant difference in clinical scores of pain, function, and quality of life among patients younger or older than 65 years old, thus suggesting that TKA can be an effective treatment even in younger patients. It is interesting to note that although some studies have reported higher rates of dissatisfaction among younger patients, age may not be a predictive factor for dissatisfaction in itself.…”

Enhanced recovery after surgery for major orthopedic surgery: a narrative review

“…Foni et al. described that the implementation of CP in TKA was related to a reduction in the length of hospital stay from 6.3 to 4.9 days, and a reduction in cost compared with the control group [ 121 ]. Schwarzkopf et al.…”

Effects of implementing a clinical pathway on antibiotic prophylaxis for patients who underwent an elective surgery

“…Furthermore, it increased the rate of administration of prophylactic antibiotics, within 60 min, prior to the incision from 87.4 to 99.2%. Moreover, the rate of discontinuation of prophylactic antibiotics within 48 h increased from 51.6 to 84.7% 18 . CP implementation was associated with less antibiotic use in a retrospective study on patients undergoing endoscopic retrograde cholangiopancreatography for common bile duct stones 19 .…”