High efficiency pathway for lower limb orthopedic surgery: A matched historic cohort study

In 2017, our institution implemented a high efficiency (HE) pathway for lower limb orthopedic surgery. The employed strategy included patient selection, surgical instrument standardization, preoperative surgical nerve blocks, avoidance of general anesthesia and bypassing phase one recovery. We conducted a historic cohort study whose primary outcome was the postoperative recovery time between the HE and traditional (T) pathway.

To determine whether the implementation of a HE pathway was correlated with a reduction in postoperative recovery time.

Patients who had unilateral elective lower limb orthopedic procedures through the T and HE pathway were screened between 2017 to 2019. Patients were at least 18 years old, and American Society of Anesthesiologists (ASA) Physical Status I to III without major systemic comorbidities were included. Propensity score was generated using multivariable regression taking age, body mass index, sex, ASA class and surgical type as covariates using nearest neighbour methods between the two pathways. Mann Whitney U test were used to analyzed total postoperative time.

There was an associated reduction in total postoperative recovery time of 63 minutes (95%CI: -69 to -57) in the HE group. The operating room time and total length of stay also had an associated decrease of 20 minutes (95%CI: -23 to -17) and 84 minutes (95%CI: -92 to -75) respectively.

Utilizing multifaceted strategies to improve perioperative efficiency was associated with a reduction in the postoperative recovery time in our retrospective study. This model can be a potential strategy to deal with surgical backlog in the face of ongoing human resource challenges.