Knee replacement patients go home from the hospital sooner, are more satisfied and spend less for their treatment when a physician anesthesiologist coordinates their care. That is the result of a study by researchers at Kaiser Permanente, the nation’s largest Health Maintenance Organization.
Better Outcomes When Anesthesiologists Coordinate TKA Care
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Secondary
The researchers collected outcomes data after they had put into practice a system called a “perioperative surgical home (PSH). This consisted of a physician-led system of care that guides the patients through the entire surgical experience.
The study included 546 patients who had knee replacement surgery within one year prior to the implementation of the PSH and 518 who had the procedure within one year after the PSH was in place. The national average for length of stay after knee replacement is four days. Forty percent of patients spend time at a skilled nursing facility after leaving the hospital.
In the study, the average length of stay in the hospital for the PSH group was 1.9 days, versus 3.2 days before the PSH was instituted. In the PSH group, 94% of patients went home after being released from the hospital and 6% went to a skilled nursing facility. In the pre-PSH group, 80% of patients went home after being released from the hospital and 20% went to a skilled nursing facility.
“The patient rather than the surgery becomes the center, and the physician anesthesiologist proactively manages all aspects of care, before, during and after the surgery, ” says Chunyuan Qiu, M.D., lead author and physician anesthesiologist, Kaiser Permanente Baldwin Park Medical Center, Baldwin Park, California. “Before the PSH was implemented, there was no quarterback overseeing the entire process, leading to fragmented, disjointed care that caused delays.”.
The 30-day readmission rate was low in both groups. In the pre-PHS group doctors readmitted 1.2% to the hospital while .9% of the PSH group were readmitted. Kaiser Permanente officials estimate that the reduced length of stay in the hospital and skilled nursing facility for all patients saved $1.4 million.
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This is a fascinating development. In my practice we've seen similar outcomes with the revised protocol. The key differentiator seems to be patient selection criteria. Has anyone else noticed the correlation with BMI thresholds?
Great point. I'd push back slightly on the conclusion, the sample size in the cited study is too small to draw population-level inferences. That said, the directional signal is compelling and worth a larger RCT.
We implemented a similar approach last year. Early results are promising but we're still gathering 12-month follow-up data. Happy to share our protocol if anyone is interested.
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