INTEGRATED CARE PATHWAYS AND OUTCOME IN TOTAL KNEE ARTHROPLASTY

Abstract

This study aimed to evaluate the effect of using ICPs (Integrated Care Pathways) on the outcome of TKA.

Prospective data was collected from 429 patients (130 from 2 sites that use 1CPs and 299 from 4 sites that did not). Pre-operatively and at 12 months an independent researcher performed a clinical knee examination and patients completed WOMAC and SF-36 questionnaires. At 12 months patients answered additional questions on satisfaction with outcome. The follow-up rate was 86%.

The median length of stay (LOS) in the ICP group was 9 days compared with 12 in the non-ICP group (p < 0. 001). After adjusting for other significant variables, ICP site was shown to be the most significant factor in shorter LOS (p < 0. 001). Following discharge, 78% of the ICP group and 47% of the non-ICP group received outpatient physiotherapy (p < 0. 001). Logistic regression analysis showed that the ICP group were 4 times more likely to receive outpatient physiotherapy (odds ratio = 4. 35, p < 0. 001). After adjusting for other significant variables and baseline values, at 12 months the ICP group had significantly less pain (p = 0. 041) and significantly better function (p < 0. 00 1) than the non-ICP group. There was no difference in the number of postoperative orthopaedic complications (p = 0. 64). At 12 months, 83% of the ICP group were very satisfied with their surgery compared to 70% of the non-ICP group (p = 0. 009). Logistic regression showed that the ICP group were over twice as likely to be very satisfied with their outcome at 12 months (odds ratio = 2. 27, p = 0. 029).

These results indicate that ICPs can result in shorter LOS without compromising outcome although use of outpatient physiotherapy was increased. In addition ICPs appear to result in greater patient satisfaction.