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Outcomes Assessment of Total Hip and Total Knee Arthroplasty: Critical Pathways, Variance Analysis, and Continuous Quality Improvement

Wammack, Lisa M.S.N., R.N.; Mabrey, Jay D. M.D.

Continuing Education: CE Feature Article

Using critical pathways, with variance analysis and continuous quality improvement techniques to refine the pathways, the efficiency of total hip and total knee surgeries in one academic health center was maximized. Using a retrospective cohort study design, complications, readmissions, morbidity/mortality, and function scores were examined in two groups of patients attended by the same surgeon for the year before and the year after the implementation of an outcomes management program. The length of stay was reduced by 57% for knee patients and by 46% for hip patients. Hospital costs were reduced 11% for all knees and 38% for hips. Complications were also significantly reduced. There was no statistically significant difference between pre- or postoperative knee or hip outcome scores. The program resulted in significant savings without adversely affecting overall outcome.

LISA WAMMACK is a medical-surgical clinical nurse specialist working in orthopedics at University Hospital in San Antonio. Her main focus is total hip and knee replacement procedures, and she consults in case management projects.

JAY D MABREY is an assistant professor of orthopedic surgery in the Department of Orthopedics at the University of Texas Health Science Center in San Antonio. He is Director of Adult Reconstruction and specializes in total hip and knee replacements.

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