Decreasing Medical Complications for Total Knee Arthroplasty: Effect of Critical Pathways on Outcomes


Show simple item record Husni, M Elaine en_US Losina, Elena en_US Fossel, Anne H en_US Solomon, Daniel H en_US Mahomed, Nizar N en_US Katz, Jeffrey N en_US 2011-12-29T22:21:53Z 2011-12-29T22:21:53Z 2010 en_US 2010-7-14 en_US
dc.identifier.citation Husni, M Elaine, Elena Losina, Anne H Fossel, Daniel H Solomon, Nizar N Mahomed, Jeffrey N Katz. "Decreasing medical complications for total knee arthroplasty: Effect of Critical Pathways on Outcomes" BMC Musculoskeletal Disorders 11:160. (2010) en_US
dc.identifier.issn 1471-2474 en_US
dc.description.abstract BACKGROUND: Studies on critical pathway use have demonstrated decreased length of stay and cost without compromise in quality of care. However, pathway effectiveness is difficult to determine given methodological flaws, such as small or single center cohorts. We studied the effect of critical pathways on total knee replacement outcomes in a large population-based study. METHODS: We identified hospitals in four US states that performed total knee replacements. We sent a questionnaire to surgical administrators in these hospitals including items about critical pathway use and hospital characteristics potentially related to outcomes. Patient data were obtained from Medicare claims, including demographics, comorbidities, 90-day postoperative complications and length of hospital stay. The principal outcome measure was the risk of having one or more postoperative complications. RESULTS: Two hundred ninety five hospitals (73%) responded to the questionnaire, with 201 reporting the use of critical pathways. 9,157 Medicare beneficiaries underwent TKR in these hospitals with a mean age of 74 years (± 5.8). After adjusting for both patient and hospital related variables, patients in hospitals with pathways were 32% less likely to have a postoperative complication compared to patients in hospitals without pathways (OR 0.68, 95% CI 0.50-0.92). Patients managed on a critical pathway had an average length of stay 0.5 days (95% CI 0.3-0.6) shorter than patients not managed on a pathway. CONCLUSION: Medicare patients undergoing total knee replacement surgery in hospitals that used critical pathways had fewer postoperative complications than patients in hospitals without pathways, even after adjusting for patient and hospital related factors. This study has helped to establish that critical pathway use is associated with lower rates of postoperative mortality and complications following total knee replacement after adjusting for measured variables. en_US
dc.language.iso en en_US
dc.publisher BioMed Central en_US
dc.rights Copyright 2010 Husni et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. en_US
dc.rights.uri en_US
dc.title Decreasing Medical Complications for Total Knee Arthroplasty: Effect of Critical Pathways on Outcomes en_US
dc.type article en_US
dc.identifier.doi 10.1186/1471-2474-11-160 en_US
dc.identifier.pubmedid 20630086 en_US
dc.identifier.pmcid 2918540 en_US

Files in this item

This item appears in the following Collection(s)

Show simple item record

Search OpenBU

Advanced Search


Deposit Materials