Standardized total knee arthroplasty pathway improves outcomes in minority patients

OBJECTIVES: Inferior total knee arthroplasty (TKA) outcomes are reported in minority populations. Standardized TKA pathways improve outcomes but have not been studied extensively in minority populations. This study evaluated the impact of TKA pathway standardization at an urban teaching hospital that predominantly treats minority patients. STUDY DESIGN: Retrospective cohort study. METHODS: This study compared primary TKA outcomes before and after implementation of a standardized multidisciplinary pathway that emphasized preoperative education and discharge planning, preemptive multimodal pain control, and early rehabilitation. Patients were grouped as "nonpathway" (n=144) or "pathway" (n=182) based on whether they underwent TKA before or after pathway implementation. Outcomes included length of stay (LOS), patient-controlled analgesia (PCA) use, blood transfusion, postoperative hemoglobin, complications, and discharge disposition. Analysis involved negative binomial and multiple logistic regression models, t tests, and Fisher's exact tests. RESULTS: Mean (SD) age was 61.6 (8.7) years, and 36.5% were men. Ethnicity of the patients included Hispanic (44.5%), African American (27.9%), Asian (14.1%), and White (12.9%). Pathway and nonpathway patients were similar demographically and racially. Pathway patients had shorter LOS (P=.04), less PCA use (P<.001), more frequent discharge home (P=.03), fewer transfusions (P=.002), and higher postoperative hemoglobin (P<.001). Overall incidence of complications was similar (P=.61). Nonpathway patients developed more cardiopulmonary complications (P=.02), whereas pathway patients had more wound dehiscence (P=.01). CONCLUSIONS: Compared with nonpathway patients, standardized TKA pathway patients had shorter LOS, decreased PCA use, increased discharge to home, fewer blood transfusions, and higher postoperative hemoglobin, with no difference in total incidence of complication.