A Physician-led Care Redesign Blunts Predictors of Length of Stay After Total Hip and Knee Arthroplasty


We questioned to what extent traditional predictors of care team burden (via increased length of stay [LOS] after total joint arthroplasty [TJA]) were able to be mitigated through alteration of the care pathway. The impact on LOS of traditional patient risk factors, as well as encounter variables, were analyzed for a consecutive set of patients undergoing surgery before and after a physician-initiated arthroplasty care pathway redesign. We analyzed the impact of these variables on LOS, discharge disposition, and 90-day readmission; separate analyses were performed pre- and post-redesign for LOS. Several patient factors (Risk Assessment and Prediction Tool, body mass index, age, insurance type, smoking) predicted longer LOS in the pre-redesign cohort; post-redesign, only ambulation on the day of surgery and anticoagulation type were predictive. The redesign also lessened the aggregate impact of the patient-specific risk factors, resulting in reduced variation in LOS. Physician leadership of care pathways can reduce the impact of factors that have portended longer LOS, thereby reducing variability in LOS and costs for disparate patient populations while driving improvements in value-based care indices. (Journal of Surgical Orthopaedic Advances 32(2):097–101, 2023)

Key words: length of stay (LOS), value-based care, care pathway redesign, postoperative mobilization, health policy, Comprehensive Care for Joint Replacement Model (CJR)

Arnold J. Silverberg, MD; Hari K. Parvataneni, MD; Hernan A. Prieto, MD; Justin T. Deen; Terrie Vasilopoulos, PhD; MaryBeth Horodyski, EdD; and Chancellor F. Gray, MD