Clinical Pathway Management of Total Knee Arthroplasty

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

doi:10.1097/00003086-199712000-00017

Cited by 79 publications

(66 citation statements)

References 12 publications

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“…In fact, other authors report decreasing the length of stay decreased complications, improved outcomes, and increased patient satisfaction in total joint replacement [10,14,17,19]. Our data also demonstrate early discharge does not result in excessive readmissions or other postdischarge complications due to early discharge.…”

Section: Discussionsupporting

confidence: 68%

Newer Anesthesia and Rehabilitation Protocols Enable Outpatient Hip Replacement in Selected Patients

Berger

Sanders

Thill

et al. 2009

Clin Orthop Relat Res

255

177

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Advancements in the surgical approach, anesthetic technique, and the initiation of rapid rehabilitation protocols have decreased the duration of hospitalization and subsequent length of recovery following elective total hip arthroplasty. We assessed the feasibility and safety of outpatient total hip arthroplasty in 150 consectutive patients. A comprehensive perioperative anesthesia and rehabilitation protocol including preoperative teaching, regional anesthesia, and preemptive oral analgesia and antiemetic therapy was implemented around a minimally invasive surgical technique. A rapid rehabilitation pathway was started immediately after surgery and patients had the option of being discharged to home the day of surgery if standard discharge criteria were met. All 150 patients were discharged to home the day of surgery, at which time 131 patients were able to walk without assistive devices.

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Section: Discussionsupporting

confidence: 68%

Newer Anesthesia and Rehabilitation Protocols Enable Outpatient Hip Replacement in Selected Patients

Berger

Sanders

Thill

et al. 2009

Clin Orthop Relat Res

255

177

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“…Finally, high-energy trauma fractures might also be considered since low bone mass also contributes to fractures following severe trauma [29]. Clinical pathways are already applied to surgical diagnosis [30] and post-surgical care, particularly in orthopedics [31][32][33], cardiac surgery [34], and urology [35], and for nonsurgical patients, such as those with inflammatory arthritis [36], or infectious [37,38] or thrombotic [39] diseases. The results indicate a reduction in length of hospital stay and in healthcare costs without interfering with the quality of care [30,33,38,40].…”

Section: Discussionmentioning

confidence: 99%

An Osteoporosis Clinical Pathway for the Medical Management of Patients with Low-Trauma Fracture

Chevalley¹,

Hoffmeyer

Bonjour³

et al. 2002

Osteoporos Int

157

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Patients with an osteoporotic fracture have at least a 2-fold risk for additional fracture and should benefit from targeted diagnostic and treatment procedures for osteoporosis. To address this issue, we set up an osteoporosis clinical pathway (OCP) for the medical management of patients with low-trauma fracture. Following acute management of the fracture by the orthopedic team, patients are enrolled in the pathway, which is based on an interaction between the OCP multidisciplinary team, orthopedic surgeons and/or primary care physicians. After collection of patient data, suggestions for additional diagnostic examinations with their interpretation, and treatment proposals are made. Patients and their families are also invited to attend a multidisciplinary interactive educational program on physical therapy, lifestyle habits and nutrition. During a 36-month period, 385 patients (311 women, 74 men; mean age +/- SD: 73.0 +/- 13.5 years; hip fracture 45%, ankle/tibia 24%, proximal humerus 8.6%, spine 5.5%, pelvis 3.9%, distal forearm 3.6%, other sites 17.4%) were enrolled in the OCP. An osteoporosis awareness questionnaire administered within 10 days of fracture showed that 73% of patients believed that their fracture was not related to the disease. Dual-energy X-ray absorptiometry, performed in 63% of patients, showed that 86% had low bone mass or osteoporosis. Specific antiosteoporotic therapy was proposed for 33% of patients in addition to calcium and vitamin D supplements, the latter suggested for 93%. A survey performed in 216 patients 6 months later, indicated that 63% of the suggested treatments had been prescribed and that 67% of this group were continuing treatment. Such a clinical pathway for the medical management of low-trauma fracture can help to identify patients with osteoporosis in a high-risk population, provide support to the orthopedic surgeon and/or the primary care physician for diagnostic and treatment procedures, and should significantly contribute to increase awareness of the disease in patients and their families.

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“…The reasons for maintaining patients in the acute care hospital setting immediately after TKA have included patient and physician concerns about uncontrolled pain, decreased mobility, and the possibility of perioperative complications. However, the average length of stay after TKA and UKA has decreased substantially in recent years through the judicious use of improved postoperative clinical pathways [5,7,8]. These pathways have included improved pain management protocols, early mobilization, and meticulous monitoring and early preventive intervention for common postoperative medical complications.…”

Section: Introductionmentioning

confidence: 99%

“…Previous authors have demonstrated the average length of stay can be decreased without increasing perioperative complication rates or decreasing patient satisfaction [6,9]. Some authors have also reported decreasing the length of hospitalization can minimize complications, improve outcomes, and increase patient satisfaction after total joint arthroplasty [5,7,8,11]. Anterior cruciate ligament reconstruction, laparoscopic cholecystectomy, and laparoscopic appendectomy are examples of surgical procedures previously necessitating inpatient hospitalization that are now routinely performed safely and effectively as outpatient procedures [10].…”

Section: Introductionmentioning

confidence: 99%

The Feasibility and Perioperative Complications of Outpatient Knee Arthroplasty

Berger

Kusuma

Sanders

et al. 2009

Clin Orthop Relat Res

252

176

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The duration of hospitalization and subsequent length of recovery after elective knee arthroplasty have decreased. We hypothesized same-day discharge following either a unicompartmental (UKA) or total knee arthroplasty (TKA) in an unselected group of patients would not result in a higher perioperative complication rate than standardlength hospitalization when following a comprehensive perioperative clinical pathway, including preoperative teaching, regional anesthesia, preemptive oral analgesia, preemptive antiemetics, and a rapid rehabilitation protocol. We prospectively followed 111 of all 121 patients who had primary knee arthroplasty completed by noon and who agreed to be followed prospectively; 25 had UKA and 86 TKA. Of the 111 patients, 104 (94%, 24 with UKA and 80 with TKA) met discharge criteria and were discharged directly to home the day of surgery. Nausea requiring additional treatment before discharge was the most common reason for a delay in discharge. There were four (3.6%) readmissions (all with TKA) and one emergency room visit without readmission (in a patient with a TKA) within the first week after surgery, while there were four subsequent readmissions (3.6%) and one additional emergency room visit without readmission within three months of surgery, all among patients undergoing TKA. There were no deaths, cardiac events, or pulmonary complications during this study. Outpatient knee arthroplasty surgery is feasible in a large percentage of patients yet early readmissions may be decreased with a prolonged hospitalization.

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Clinical Pathway Management of Total Knee Arthroplasty

Cited by 79 publications

References 12 publications

Newer Anesthesia and Rehabilitation Protocols Enable Outpatient Hip Replacement in Selected Patients

Newer Anesthesia and Rehabilitation Protocols Enable Outpatient Hip Replacement in Selected Patients

An Osteoporosis Clinical Pathway for the Medical Management of Patients with Low-Trauma Fracture

The Feasibility and Perioperative Complications of Outpatient Knee Arthroplasty

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