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Anesthesiology 2014: Anesthesiologist-Led Care for TKA Patients

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The Particulars: The high perioperative and postoperative costs associated with total knee arthroplasty (TKA) along with increasing demand from the aging United States population is placing greater financial strain on the healthcare system, according to recent data. A fast-tracking pathway for TKA may relieve some of this strain.

Data Breakdown: Researchers conducted a before-and-after analysis in which they assessed the impact of implementing a fast-tracking pathway that used a patient-centered, anesthesiologist-led, postoperative recovery team for patients undergoing TKA. Approximately 500 patients underwent TKA within a year prior to the implementation of a fast-tracking pathway and were compared with about 550 patients who underwent TKA during the first year of the intervention. The rate of patients who were able to bypass placement in a skilled nursing facility following TKA was 80% among those seen prior to the intervention, compared with a rate of 94% among those seen during the first year of the intervention. The 30-day readmission rate decreased from 1.2% before implementing the intervention to 0.9% post-implementation.

Take Home Pearls: A patient-centered, anesthesiologist-led system of team-based care appears to significantly increase the rate of TKA patients who can bypass being placed into a skilled nursing facility. This approach also appeared to decrease the rate of 30-day readmissions when compared with traditional anesthesia practices.

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