No difference in patient-reported outcome measures between private and public hospitals in the Netherlands: a cross-sectional analysis based on 170,150 hip and knee arthroplasties from the Dutch Arthroplasty Register.

background and purposePrivate hospitals have become more frequent healthcare providers for arthroplasty surgery in the Netherlands. The aim of our study was to assess patient-reported outcome measures (PROMs) in patients who received primary total hip arthroplasty (THA), total knee arthroplasty (TKA), and unicompartmental knee arthroplasty (UKA) in private hospitals compared with patients from public hospitals, and to assess access to care based on mean travel distance to the healthcare facility.

methodsPatients operated on between 2014 and 2023 were included. Patient characteristics, preoperative, 3- or 6-, and 12 months postoperative PROMs (Numeric Pain Rating Scale [NRS] pain, EuroQoL 5-Dimensions [EQ-5D-5L], Hip disability and Osteoarthritis Outcome Score [HOOS-PS], Knee Injury and Osteoarthritis Outcome Score [KOOS-PS], Oxford Hip Score [OHS], and Oxford Knee Score [OKS]) were retrieved from the LROI. For analysis, repeated measurements were performed, using mixed-effect models adjusted for confounders. Primary endpoints for inference were NRS pain during activity, HOOS/KOOS-PS, and OHS/OKS at 3 months follow-up. Mean travel distance to the hospital was compared, as measure for access to care.

results146,303 primary THAs, TKAs, and UKAs performed in public hospitals and 23,847 in private hospitals were included. Patients undergoing arthroplasty in private hospitals were generally younger and had a higher socioeconomic status and lower body mass index and American Society of Anesthesiologists Physical Status class. Both patients from private and public hospitals improved similarly and significantly after surgery. At 3-month follow-up, public hospitals showed marginal but statistically significant advantages in HOOS/KOOS-PS for THA, TKA, and UKA (mean differences 0.5 [95% confidence interval (CI) 0.1-0.9], 0.5 [CI 0.1-0.9], and 1.3 [CI 0.5-2.1], respectively). OKS favored public hospitals for TKA and UKA (-0.4 [CI -0.6 to -0.2] and -0.6 [CI -1.0 to -0.1]). NRS pain during activity favored private hospitals for TKA (-0.2 [CI -0.3 to -0.1]). All absolute differences were small and without statistical significance. Mean travel distance was significantly shorter for patients treated in public hospitals.

conclusionThere is no difference in PROMs between public and private hospitals after primary THA, TKA and UKA in the Netherlands. Based on mean travel distance, access to care was not compromised for high-risk patients.