The Journal of Bone and Joint Surgery (American) 84:348-353 (2002)
© 2002 The Journal of Bone and Joint Surgery, Inc.
Impact of Cost Reduction Programs on Short-Term Patient Outcome and Hospital Cost of Total Knee Arthroplasty
William L. Healy, MD,
Richard Iorio, MD,
John Ko, MDPhD,
David Appleby, MPH and
David W. Lemos, MA
Investigation performed at the Department of Orthopaedic Surgery,
Lahey Clinic Medical Center, Burlington, Massachusetts
William L. Healy, MD
Richard Iorio, MD
John Ko, MD, PhD
David Appleby, MPH
David W. Lemos, MA
Department of Orthopaedic Surgery, Lahey Clinic Medical Center,
41 Mall Road, Burlington, MA 01805
Although none of the authors has received or will receive benefits
for personal or professional use from a commercial party related
directly or indirectly to the subject of this article, benefits
have been or will be received, but are directed solely to a research
fund, foundation, educational institution, or other nonprofit organization
with which one or more of the authors is associated. Funds were
received in partial support of the research or clinical study presented
in this article. The funding source was Harvard Community Health
Plan.
A commentary is available with the electronic versions of this article,
on our web site (www.jbjs.org) and on our quarterly CD-ROM (call
our subscription department, at 781-449-9780, to order the CD-ROM).
Background: During the 1990s, cost reduction
programs were developed to decrease the hospital cost of total knee
arthroplasty. The purpose of this study was to evaluate the impact
of hospital cost reduction programs for total knee arthroplasty
on patient outcome at our hospital.
Methods: We evaluated 159 patients who had undergone
unilateral primary total knee arthroplasty for the treatment of
osteoarthritis at the Lahey Clinic. The results of fifty-six knee
replacements performed in 1992 without a clinical pathway or a knee-implant
standardization program (the control group) were compared with the
results of 103 knee replacements performed in 1995 with a clinical
pathway and a knee-implant standardization program (the study group).
Before the operation, the two patient populations were similar in
terms of age, pain score on a visual analog scale, and clinical
knee scores; the groups were also similar with regard to the surgical approach
and the time in the operating room. The minimum duration of follow-up
was eight years for the control group and five years for the study
group.
Results: All patients in both groups had excellent
relief of pain and improvement in function. There were no differences
in clinical outcome between the patient groups. The rate of patient satisfaction
was 98% in the control group and 99% in the study
group. Implementation of the clinical pathway was associated with
a reduction in the average length of the stay in the hospital from
6.79 days in 1992 to 4.16 days in 1995. Implementation of the knee-implant
standardization program was associated with increased use of all-polyethylene
tibial components in 1995. Hospital cost adjusted for medical inflation
was reduced 19% with the implementation of the clinical pathway
and the knee-implant standardization program.
Conclusions: The clinical pathway and the knee-implant
standardization program reduced resource utilization and hospital
cost for total knee arthroplasty without affecting short-term patient outcome
in our hospital. Orthopaedic surgeons should carefully evaluate
cost reduction programs, which may affect their patients, in order
to maintain high-quality orthopaedic care and consistently successful
patient outcomes.
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