Revision Total Hip and Knee Arthroplasty are Associated with Lower Hospital Consumer Assessment of Healthcare Providers and Systems Patient Satisfaction Scores Compared with Primary Arthroplasty

Who: Michael R. Mercier, BA; Anoop R. Galivanche, BS; Neil Pathak, MD; Elbert J. Mets, BA; David A. Molho, MD; Ali H. Elaydi, MD; Jonathan N. Grauer, MD; Lee E. Rubin, MD

Overview: As the rates of primary total joint arthroplasty continue to rise, so do the rates of revision. Revision total hip arthroplasty (THA) and total knee arthroplasty (TKA) are performed more frequently in larger centers, are associated with higher morbidity, and may have different patient satisfaction outcomes. This study compares the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) research findings between patients who underwent primary versus revision THA or TKA.

All adult patients who underwent clinical, elective, primary and revision THA or TKA in a single institution were selected for retrospective analysis. Patient demographics, co-morbidities, functional status, surgical variables, results at 30 days, and HCAHPS scores were assessed. Univariate and multivariate analyzes were performed to determine the correlations between the above variables and study top-box HCAHPS scores for primary versus revision THA and TKA.

Of the 2,707 patients who met the inclusion criteria and returned the HCAHPS survey, primary THA was documented in 1,075 patients (39.71%), revision THA in 75 (2.77%), primary TKA in 1,497 (55, 30%) and revision TKA in 60 (2.22%). Revision THA patients were more functionally dependent and TKA patients had a higher American Society of Anesthesiologists score than their primary comparators. Revisions had longer hospital stays for both procedures. For THA, revision THA patients showed lower overall top-box rates compared to primary THA patients (71.64% vs 75.67% top-box, P < 0.001) and lower physician care subsection scores (76 .26% vs 85.34%, P < 0.001) of the HCAHPS survey. Similarly, revision TKA patients for TKA showed lower overall top-box rates (76.13% vs. 79.22%, p < 0.013) and lower physician care subsection scores (66.28% vs. 83.65%). , p < 0.001) from the HCAHPS survey.

For both THA and TKA, revision procedures were associated with lower HCAHPS total scores and physician rated care. This suggests that HCAHPS scores may be biased by factors beyond the surgeon’s control, such as the complexity associated with revision procedures.

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