Today's News

Saturday, February 24, 1996

Clinical pathways reduce cost of hip arthroplasty, study says

Orthopaedic surgeons from the Lahey Hitchcock Medical Center, Burlington, Mass., reported in scientific paper 277 Saturday that a clinical pathway can reduce hospital cost for total hip arthroplasty. The clinical pathway provided orthopaedic surgeons with a course of action to follow from the time total hip arthroplasty is scheduled until the patient is discharged from the hospital. The orthopaedic surgeons also proved that the clinical pathway did not affect the quality of a patient's outcome.

The Hip Implant Standardization Program (HISP) was used for hip implant selection. Patients were matched with specific implants for their demand on the implant.

The HISP program has saved the medical center 8.5 percent on hip implant costs, reported study co-author William L. Healy, MD, chairman, department of orthopaedic surgery, Lahey Hitchcock Medical Center.

To test the effectiveness of the programs, Dr. Healy and his colleagues evaluated the outcomes of 127 total hip arthroplasty operations. Two patient groups were analyzed - 63 patients treated without a clinical pathway and HISP in 1991, and 64 patients treated using a clinical pathway and HISP in 1993.

The two patient populations were similar in age, weight, activity, general health status, and preoperative hip scores. "Each group also had excellent clinical results, and were relatively pain-free following surgery," said Dr. Healy.

Questionnaires were administered by the hospital staff to patients following their surgery to determine their ability to resume normal activities as well as their overall satisfaction with the procedure.

"No major differences in the surgical outcome and satisfaction of the patients from 1991 and 1993 were found which indicates that the clinical pathway and implant standardization program did not adversely affect the quality of care patients received at the hospital," said Dr. Healy.

When using the HISP, orthopaedic surgeons at Lahey Hitchcock Medical Center assign total hip arthroplasty patients to one of four categories depending on the demand patients are expected to place on the implant. The demand is quantified by five objective criteria: age, weight, expected activity, general health, and bone stock.

Hip implants are assigned to demand categories based on their projected ability to handle the patient's anticipated demand. In general, the cost of implants decreases from high demand to low demand categories.

The development of a clinical pathway for total hip arthroplasty patients helped the orthopaedic surgeons reduce delays in scheduling, tests, and rehabilitation. The improvements played a key role in reducing the average patient length of stay from 8.49 days in 1991 to 5.8 days in 1993, reported Dr. Healy.

Co-authors of the study with Dr. Healy, all from the Lahey Hitchcock Medical Center, department of orthopaedic surgery, are Michael E. Ayers, AB; Richard Iorio, MD; Douglas A. Patch, MD; and Bernard A. Pfeifer, MD.

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