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dc.contributor.authorHusni, M. Elaineen_US
dc.contributor.authorLosina, Elenaen_US
dc.contributor.authorFossel, Anne H.en_US
dc.contributor.authorSolomon, Daniel H.en_US
dc.contributor.authorMahomed, Nizam N.en_US
dc.contributor.authorKatz, Jeffrey N.en_US
dc.date.accessioned2011-12-29T22:21:53Z
dc.date.available2011-12-29T22:21:53Z
dc.date.copyright2010
dc.date.issued2010-7-14
dc.identifier.citationHusni, 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)
dc.identifier.issn1471-2474
dc.identifier.urihttp://hdl.handle.net/2144/2569
dc.description.abstractBACKGROUND: 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.isoenen_US
dc.publisherBioMed Centralen_US
dc.rightsCopyright 2010 Husni et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.en_US
dc.rights.urihttp://creativecommons.org/licenses/by/2.0
dc.titleDecreasing Medical Complications for Total Knee Arthroplasty: Effect of Critical Pathways on Outcomesen_US
dc.typearticleen_US
dc.identifier.doi10.1186/1471-2474-11-160
dc.identifier.pubmedid20630086
dc.identifier.pmcid2918540


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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 (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Except where otherwise noted, this item's license is described as 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 (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.