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International Orthopaedics
Published in: International Orthopaedics 6/2013

01-06-2013 | Original Paper

Integrated care pathways in lower-limb arthroplasty: are they effective in reducing length of hospital stay?

Authors: Stephan Christian Mertes, Shruti Raut, Vikas Khanduja

Published in: International Orthopaedics | Issue 6/2013

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Abstract

Purpose

The aim of this study was to examine the effect of an integrated care pathway (ICP) for total hip and knee arthroplasty (THA/TKA) on length of stay (LOS), day of surgery admission rate (DOSA) and postoperative length of stay (POLOS).

Methods

Three hundred and eight THAs and 299 TKAs were assessed in a retrospective before–after trial design. LOS, POLOS and DOSA were recorded for patients before and after introduction of the ICP. The ICP encompassed a patient education programme, specific daily management goals, variance mapping, daily facilitated meetings and a DOSA policy. Subgroup analysis according to age and gender was also performed.

Results

Mean LOS was significantly reduced by 1.4 (from 6.9 to 5.5) days for THA and 0.8 (from 6.4 to 5.6) days for TKA. Elderly patients and men achieved greater LOS reductions than their counterparts for both operations. Younger patients undergoing THA achieved a significantly higher DOSA rate than older patients (89 % vs 71 %, p = 0.010); however, this difference was not observed in the TKA population. Mean POLOS for THA was reduced by 0.6 (from 5.9 to 5.3) days, again with the greatest benefit seen in elderly and male patients. POLOS for TKA patients was not significantly affected by the ICP.

Conclusions

The introduction of an ICP reduced LOS by 1.4 days for THA and 0.8 days for TKA. Elderly and male patients benefitted most.
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Metadata
Title
Integrated care pathways in lower-limb arthroplasty: are they effective in reducing length of hospital stay?
Authors
Stephan Christian Mertes
Shruti Raut
Vikas Khanduja
Publication date
01-06-2013
Publisher
Springer-Verlag
Published in
International Orthopaedics / Issue 6/2013
Print ISSN: 0341-2695
Electronic ISSN: 1432-5195
DOI
https://doi.org/10.1007/s00264-013-1829-1

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