Geographical variations in patient-reported outcomes after total hip arthroplasty between 2008 - 2012

Ingrid Osika Friberg,Göran Garellick,Anke Samulowitz,Szilárd Nemes,Ola Rolfson,Linnea Oldsberg

doi:10.1186/s12913-019-4171-5

Abstract

BackgroundHealth care on equal terms is a cornerstone of the Swedish health care system. Total hip arthroplasty (THA) is considered a success story in Sweden with low frequency of reoperations and restored health-related quality of life (HRQoL). Administratively, health care in Sweden is locally self-governed by 21 counties. In this longitudinal nation-wide observational study we assessed the possible geographical variations in 1-year follow-up patient-reported outcomes (PROs): EQ-5D index, EQ VAS, Pain VAS and Satisfaction VAS.MethodsStudy population consisted of 36,235 Swedish THA patients, operated during 2008 to 2012 due to hip osteoarthritis. Individual data came from Swedish Hip Arthroplasty Register, Statistics Sweden and National Board of Health and Welfare. We used descriptive statistics together with multivariable regression analysis to analyse the data.ResultsWe observed county level differences in both preoperative and postoperative PROs. The results showed that the differences observed in preoperative PROs could not fully explain the differences observed in postoperative PROs, even after adjustment for patient demographics (age, sex, BMI, Elixhauser comorbidity index, marital status, educational level and disposable income). This indicates that other factors might influence the outcome after THA.ConclusionLikely, structural and process differences such as indication for surgery have an influence on PROs after surgery. Standardization of care at hospital levels may decrease geographical variations in postoperative HRQoL. Remaining differences will then possibly be associated to patient demographics.

Highlights

Health care on equal terms is a cornerstone of the Swedish health care system
The biggest improvement was seen in pain relief, thereafter in EQ-5D index and EQ Satisfaction Visual Analogue Scale (VAS) (Fig. 2)
The predictive power at county level was high with 66.5% of the county-wise variation of the EQ-5D index was explained by the considered co-variates, 46.1% for the EQ VAS, 37.2 for Pain VAS and 35.3 for Satisfaction VAS (Fig. 4). In this longitudinal register study, we demonstrated that geographical variations in patient-reported outcomes (PROs) 1 year after Total hip arthroplasty (THA) exist

Summary

Introduction

Health care on equal terms is a cornerstone of the Swedish health care system. Total hip arthroplasty (THA) is considered a success story in Sweden with low frequency of reoperations and restored health-related quality of life (HRQoL). Health care in Sweden is locally self-governed by 21 counties. In this longitudinal nation-wide observational study we assessed the possible geographical variations in 1-year follow-up patient-reported outcomes (PROs): EQ-5D index, EQ VAS, Pain VAS and Satisfaction VAS. Every fourth person over 45 in Sweden has OA and that will most likely increase, due to an ageing population and a higher number of people with obesity [3]. This will challenge health care and increase societal costs; sick leave due to OA alone costs the social insurance system 1.4 billion SEK annually [1]

Methods

Results

Conclusion