The effect of clinical pathways in reducing hospital length of stay and hospital costs and improving functional outcomes in total hip and knee arthroplasty patients: A systematic review

Purpose. To determine the effects of clinical pathways on length of hospital stay, hospital costs, and functional outcomes in patients undergoing total hip or knee arthroplasty.;Method. Fifteen studies were reviewed independently by two reviewers using the MacDermid and Sackett levels of evidence. A third reviewer was consulted at times of disagreement on quality of the studies.;Summary of findings. Overall, most studies were moderate quality on Macdermid's scale and all but one were a 2b on the Sackett's level. All studies evaluated length of stay and reported that clinical pathways significantly reduced length of stay as compared to control groups. Four studies examined the effect of clinical pathways on hospital costs and demonstrated a significant reduction in hospital costs with the implementation of clinical pathways. Seven studies examined the effects of clinical pathways on functional outcomes but only two demonstrated a significant improvement in functional outcomes in the clinical pathway groups. Based on this review, clinical pathways are effective in reducing length of stay and hospital costs. Their effect on functional outcomes is variable and cannot be generalized.