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

Area of Science:

• Orthopedic Surgery
• Perioperative Efficiency
• Healthcare Management

Background:

• A high efficiency (HE) pathway was implemented in 2017 for lower limb orthopedic surgery.
• Strategies included optimized patient selection, standardized instruments, preoperative nerve blocks, avoidance of general anesthesia, and bypassing phase one recovery.

Purpose of the Study:

• To evaluate the correlation between the HE pathway and reduced postoperative recovery time.
• Comparison of HE pathway versus traditional (T) pathway for elective lower limb orthopedic procedures.

Main Methods:

• Retrospective cohort study (2017-2019) of patients undergoing unilateral elective lower limb orthopedic procedures.
• Inclusion criteria: age ≥18, ASA Physical Status I-III, no major comorbidities.
• Propensity score matching used to control for covariates (age, BMI, sex, ASA class, surgical type).
• Mann Whitney U test analyzed total postoperative time.

Main Results:

• The HE pathway was associated with a 63-minute reduction in total postoperative recovery time (95% CI: -69 to -57).
• Operating room time decreased by 20 minutes (95% CI: -23 to -17).
• Total length of stay was reduced by 84 minutes (95% CI: -92 to -75).

Conclusions:

• Multifaceted strategies to enhance perioperative efficiency significantly reduced postoperative recovery time.
• The HE pathway model shows potential for addressing surgical backlogs amidst human resource challenges.