A simplified pathway for total knee arthroplasty improves outcomes.

Area of Science:

• Orthopedic Surgery
• Healthcare Management
• Patient Outcomes

Background:

• Standardizing total knee arthroplasty (TKA) care pathways across large healthcare systems is challenging due to practice variations.
• Implementing complex, multi-step pathways faces significant barriers.

Purpose of the Study:

• To evaluate the effectiveness of a simplified TKA care pathway.
• To assess the impact of focusing on early patient activity and avoiding continuous urinary catheters.

Main Methods:

• A retrospective analysis of 6,154 TKA patients over two years (one year pre- and one year post-implementation).
• Implementation of a simplified pathway emphasizing early ambulation and avoidance of indwelling urinary catheters.
• Calculation of a composite score based on adherence to the two key pathway drivers.

Main Results:

• Significant improvement in the composite score, driven by increased early activity and urinary catheter avoidance.
• Associated reductions in hospital length of stay (HLOS), costs, complications, and 30-day readmissions.
• Early activity independently linked to better HLOS, fewer complications, and reduced readmissions.

Conclusions:

• A simplified TKA care pathway focusing on early activity and urinary catheter avoidance improves patient outcomes.
• This approach leads to significant reductions in HLOS, costs, complications, and readmissions.
• Key drivers of early activity and catheter avoidance are critical for optimizing TKA care pathways.