Abstract
Aim: A care pathway was introduced into our institution in July 1997 for all patients undergoing total knee arthroplasty (TKA). The aim of this study was to review the effect of this pathway with respect to outcome, length of stay, re-admissions, and complications.
Methods: Using prospectively gathered data from the patient administration system, the department audit and the care pathway system, 443 consecutive patients undergoing unilateral primary TKA between January 1995 and December 1999 were identified. There were 181 patients in the pre-pathway group and 262 pathway patients. Demographic details, complications, length of stay, discharge destination and re-admissions within 90 days were compared between the two groups. Outcome at the time of discharge was assessed in the pathway group.
Results: The patients in the pathway group were older (71.1 vs 69.4 years), the female:male ratio was higher (1.5 vs 1.3). One patient died in hospital in each group. The mean length of stay reduced from 12.8 days to 10.4 days. Only 1.6% pre-pathway and 4% of pathway patients were admitted on the day of surgery. More pathway patients went to a rehabilitation unit (13% vs 7%). The overall complication rate fell (29% to 19%) while the re-admission rate was similar (11% pre, 12% post pathway).
Conclusions: By introducing a care pathway the length of hospital stay was reduced and the complication rate fell without any increase in the re-admission rate or of compromise in the early outcome. An increase in the use of in-patient rehabilitation facilities contributed to the decrease in length of stay. Admission on the day of surgery could decrease length of stay further.
The abstracts were prepared by Professor A. J. Thurston. Correspondence should be addressed to him at the Department of Surgery, Wellington School of Medicine, PO Box 7343, Wellington South, New Zealand
