Orthopedic Surgery and Anesthesiology Surgical Improvement Strategies Project—Phase II Outcomes

Cody C. Wyles, Matthew P. Abdel, Adam W. Amundson, Christopher M. Duncan, Marci B. Pepper, Lori A. Ingalls, Kathryn W. Zavaleta, Stephen K. Smith, James L. Ryan, Michael J. Taunton, Kevin I. Perry, Hugh M. Smith

Research output: Contribution to journalArticlepeer-review


Background: Our institution previously initiated a perioperative surgical home initiative to improve quality and efficiency across the hospital arc of care of primary total knee arthroplasty and total hip arthroplasty patients. Phase II of this project aimed to (1) expand the perioperative surgical home to include revision total hip arthroplasties and total knee arthroplasties, hip preservation procedures, and reconstructions after oncologic resections; (2) expand the project to include the preoperative phase; and (3) further refine the perioperative surgical home goals accomplished in phase I. Methods: Phase II of the Orthopedic Surgery and Anesthesiology Surgical Improvement Strategies project ran from July 2018 to July 2019. The evaluated arc of care spanned from the preoperative surgical consult visit through 90 days postoperative in the expanded population described above. Results: Mean length of stay decreased from 2.2 days to 2.0 days (P < .001), 90-day readmission decreased from 3.0% to 1.6% (P < .001), and Press-Ganey scores increased from 77.1 to 79.2 (97th percentile). Mean and maximum pain scores and opioid consumption remained unchanged (lowest P = .31). Annual surgical volume increased by 10%. Composite changes in surgical volume and cost reductions equaled $5 million. Conclusion: Application of previously successful health systems engineering tools and methods in phase I of Orthopedic Surgery and Anesthesiology Surgical Improvement Strategies enabled additional evolution of an orthopedic perioperative surgical home to encompass more diverse and complex patient populations while increasing system-wide quality, safety, and financial outcomes. Improved process and outcomes metrics reflected increased efficiency across the episode of care without untoward effects. Level of Evidence: III Therapeutic.

Original languageEnglish (US)
Pages (from-to)1849-1856
Number of pages8
JournalJournal of Arthroplasty
Issue number6
StatePublished - Jun 2021


  • perioperative management
  • perioperative surgical home
  • revision total hip arthroplasty (THA)
  • revision total knee arthroplasty (TKA)
  • surgical efficiency
  • value-based healthcare

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine


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