Impact of surgical care pathways on efficiency and outcomes in orthopedic operating rooms: a historical control study.

Abstract

Objective: The impact of surgical care pathways (CP) on efficiency and patient outcomes in orthopedic operating rooms (OR) is unclear, and we aim to optimize nursing strategies and enhance service quality.

Methods: From July 2019 to June 2024, 3,836 patients undergoing orthopedic surgery at a single Grade 3 Chinese hospital were retrospectively analyzed and divided into two equal groups, with or without CP (1,918 patients in each group). The effectiveness of CP was assessed by comparing surgical site infection (SSI) rates, pathogens, OR turnover times, and patient satisfaction. Statistical analyses included between-group comparisons and multivariate logistic regressions.

Results: Baseline characteristics were balanced across groups (SMD < 0.1). Overall SSI rates were 2.1%, significantly lower in the CP group than in the Non-CP group (1.6% vs. 2.6%, P < 0.05), and translating to a 43% risk reduction (OR 0.57, 95% CI: 0.36-0.88, P < 0.05). Gram-positive bacterial infections notably decreased (OR 0.331, 95% CI: 0.093-0.959, P < 0.05). CP implementation also improved OR turnover times (95% CI: 0.504-0.839, P < 0.001) and patient satisfaction (95% CI: 1.038-2.301, P < 0.05). No significant differences were observed in other nursing quality indicators.

Conclusion: Standardized CPs are effective in significantly reducing the incidence of postoperative SSIs, particularly those caused by Gram-positive bacteria, thereby enhancing infection control. Furthermore, these pathways improve OR operational efficiency and patient satisfaction, supporting reforms in OR management practices.