Practice and Outcomes of the Perioperative Surgical Home in a California Integrated Delivery System

Anesth Analg. 2016 Sep;123(3):597-606. doi: 10.1213/ANE.0000000000001370.


Background: In this article, we report on the implementation and impact of a Perioperative Surgical Home (PSH) model for the total knee arthroplasty at an integrated delivery system (Kaiser Permanente).

Methods: A multidisciplinary committee developed and implemented a series of PSH protocols that included the entire continuum of care from the decision for surgery until 30 days after surgery. Five hundred forty-six subjects were included in the preimplementation phase (Fast Track [T-fast]), and 518 patients were included in the postimplementation phase (PSH). The primary end points of this report are hospital length of stay (LOS), postoperative skilled nursing facility (SNF) bypass rate, and 30-day readmission rate. We used a generalized linear model to assess the effect on LOS while adjusting for potential confounding variables.

Results: We found that patients assigned to the PSH pathway had a significantly shorter mean LOS compared with patients in the T-fast group (2.4 ± 2.1 days [confidence interval {CI}, 2.2-2.8] vs 3.4 ± 2.9 days [CI, 2.9-3.9]). The SNF bypass rate was significantly higher in the PSH group compared with the T-fast group (94% vs 80%, P = 0.00002, CI, -0.102 to -0.036). There was no difference in the 30 readmission rates between patients managed in the PSH track and the T-fast track (1.2% vs 0.98%).

Conclusions: Introduction of the PSH into an integrated delivery system resulted in a simultaneous reduction of LOS and SNF admission for total knee arthroplasty patients.

MeSH terms

  • Aged
  • Arthroplasty, Replacement, Knee / methods*
  • Arthroplasty, Replacement, Knee / trends
  • California / epidemiology
  • Delivery of Health Care, Integrated / methods*
  • Delivery of Health Care, Integrated / trends
  • Female
  • Humans
  • Length of Stay* / trends
  • Male
  • Middle Aged
  • Patient-Centered Care / methods*
  • Patient-Centered Care / trends
  • Perioperative Care / methods*
  • Perioperative Care / trends
  • Treatment Outcome