The Effect of a Perioperative Clinical Pathway for Knee Replacement Surgery on Hospital Costs

Macario, Alex; Horne, Michael; Goodman, Stuart B.; Vitez, Terry S.; Dexter, Franklin; Heinen, Rainee; Brown, Byron W.

doi:10.1097/00000539-199805000-00012

Cited by 49 publications

(31 citation statements)

References 21 publications

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“…Pathways have been found in numerous studies to reduce costs, decrease variation in patient care, and improve quality and satisfaction of patient care [15,16,17]. …”

Section: Discussionmentioning

confidence: 99%

Optimal perioperative anesthesia management for gynecologic interstitial brachytherapy

Nielsen¹,

Liyanage²,

Leiserowitz³

et al. 2017

jcb

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PurposeTo propose an optimal perioperative pain management clinical care pathway for interstitial brachytherapy for gynecologic cancer based on our interdepartmental experience.Material and methodsWe conducted a retrospective review of 23 women who underwent 32 interstitial brachytherapy procedures for gynecological cancers, analyzing patient demographics, type of anesthetic, medications, postoperative pain scores, adverse events, and delays in discharge. We measured the association of postoperative nausea and/or vomiting (PONV) with hydromorphone use, and postoperative pain scores and total narcotic administration with type of anesthesia.ResultsIn 91% of patients postoperative pain was managed with an epidural infusion plus, as needed (PRN), IV or patient controlled analgesia (PCA) narcotics. The most common postoperative adverse event was PONV (53%), followed by delirium (22%). Hospital discharge was delayed, at least by one night, in 26% of patients. Use of a basal rate on the PCA was associated with all cases of delayed discharge from over-sedation and PONV. The use of 5 mg or more of intravenous (IV) hydromorphone during the first 24-hours postoperatively was associated with PONV (p = 0.01). Use of a basal PCA was associated with delirium (p = 0.03). Postoperative pain scores were not significantly associated with the type of anesthesia.ConclusionsInterstitial gynecologic brachytherapy requires a multidisciplinary effort for optimal perioperative management. Our study outlines the appropriate preoperative, intraoperative, and postoperative anesthesia clinical care pathway. Decreased narcotic use during hospitalization and utilization of a patient-directed infusion may decrease side effects and allow for a more efficient hospital discharge.

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“…Pathways have been found in numerous studies to reduce costs, decrease variation in patient care, and improve quality and satisfaction of patient care [15,16,17]. …”

Section: Discussionmentioning

confidence: 99%

Optimal perioperative anesthesia management for gynecologic interstitial brachytherapy

Nielsen¹,

Liyanage²,

Leiserowitz³

et al. 2017

jcb

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“…4,5 How society will underwrite the associated costs of high-value interventions like TKA is unknown. 3,6,7 Consequently, health care providers have attempted to contain costs through various interventions such as competitive bidding for implants, 7,8 decreasing medication costs, [8][9][10] clinical pathways, 11 and shortening the period of hospitalization. 12 Using a hospital-based epidural or continuous femoral nerve block (CFNB) for 48 to 72 hours, anesthesiologists have reported shortened institutionalization from 50 to 40 days (France), 21 to 17 days (Belgium), and 5 to 4 days (United States) compared with using only intravenous opioids.…”

mentioning

confidence: 99%

Hospitalization Costs of Total Knee Arthroplasty With a Continuous Femoral Nerve Block Provided Only in the Hospital Versus on an Ambulatory Basis: A Retrospective, Case-Control, Cost-Minimization Analysis

Mariano

Williams

Woodard

et al. 2007

Regional Anesthesia and Pain Medicine

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“…1,4,[9][10][11][12][13] Because of this variability, comparison between pathways and formal scientific study are exceeding difficulty. Therefore, the goal of the current investigation was to avoid these limitations by evaluating the effect of implementing a clinical pathway on hospital LOS, clinical outcomes, and institutional costs in patients undergoing primary TKA by before-and-after study design.…”

Section: Discussionmentioning

confidence: 99%

A Self-Paired Comparison of Perioperative Outcomes Before and After Implementation of a Clinical Pathway in Patients Undergoing Total Knee Arthroplasty

Duncan

Moeschler

Horlocker

et al. 2013

Regional Anesthesia and Pain Medicine

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The Effect of a Perioperative Clinical Pathway for Knee Replacement Surgery on Hospital Costs

Cited by 49 publications

References 21 publications

Optimal perioperative anesthesia management for gynecologic interstitial brachytherapy

Optimal perioperative anesthesia management for gynecologic interstitial brachytherapy

Hospitalization Costs of Total Knee Arthroplasty With a Continuous Femoral Nerve Block Provided Only in the Hospital Versus on an Ambulatory Basis: A Retrospective, Case-Control, Cost-Minimization Analysis

A Self-Paired Comparison of Perioperative Outcomes Before and After Implementation of a Clinical Pathway in Patients Undergoing Total Knee Arthroplasty

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