Are Rapid Recovery Pathways Transferrable Across Institutions? Outcomes of a Community Hospital through the Implementation Process

Background: Prior studies have found potential disparities in outcomes for patients undergoing total joint arthroplasty (TJA) in academic vs. community and high- vs. low-volume institutions. In light of these findings and the proven efficacy of rapid recovery pathways, we sought to evaluate whether an established rapid recovery pathway was transferrable to a relatively low-volume (<300 TJAs annually) community hospital after merging with an established high-volume TJA center.

Methods: A retrospective review of 1,661 primary elective TJAs performed at a single institution from 2018 to 2024 was performed. Cases were classified into the baseline (prepathway), pathway implementation, and established pathway periods. Univariate analyses were performed to compare average length of stay (LOS), % 0/1 day LOS, and % nonhome discharges over the study periods. Univariate and multivariable analyses were performed to compare demographics and outcomes during the implementation and established pathway periods after the adoption of the health system's electronic medical record.

Results: Over the study period, average LOS declined from 3.3 ± 1.7 days during the baseline period to 1.1 ± 1.8 days during established pathway period (P < 0.001), whereas the rate of 0/1 day LOS increased from 2.8% to 84.5% (P < 0.001). The rate of nonhome discharge decreased from 48.6% at baseline to 7.5% in the established pathway period (P < 0.001). Post hoc comparisons demonstrated that significant improvements in outcomes occurred between each of the three study periods. After adoption of the electronic medical record, demographics and outcomes were similar between the pathway implementation and established pathway periods.

Conclusions: The adoption of an established rapid recovery pathway at a community hospital resulted in significant improvements in both LOS and nonhome discharge rates for TJA patients. These findings demonstrate that such pathways are transferrable and reproducible across institutions. Through the adoption of established pathways and protocols, community-based TJA programs can achieve outcomes in alignment with national benchmarks.