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Comparison of pre- and post-operative health-related quality of life and length of stay after primary total hip replacement in matched English and German patient cohorts

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Abstract

Purpose

We compare pre- and post-operative health-related quality of life (HRQoL) and length of stay after total hip replacement (THR) in matched German and English patient cohorts to test for differences in admission thresholds, clinical effectiveness and resource utilisation between the healthcare systems.

Methods

German data (n = 271) were collected in a large orthopaedic hospital in Munich, Germany; English data (n = 26,254) were collected as part of the national patient-reported outcome measures programme. HRQoL was measured using the EuroQoL-5D instrument. Propensity score matching was used to construct two patient cohorts that are comparable in terms of preoperative patient characteristics.

Results

Before matching, patients in England showed lower preoperative EQ-5D scores (0.35 vs 0.52, p < 0.001) and experienced a larger improvement in HRQoL (0.43 vs 0.33, p < 0.001) than German patients. Patients in the German cohort were more likely to report no or only moderate problems with mobility and pain preoperatively than their English counterparts. After matching, improvements in HRQoL were comparable (0.32 vs 0.33, p = 0.638); post-operative scores were slightly higher in the German cohort (0.82 vs 0.85, p = 0.585). Length of stay was substantially lower in England than in Germany (4.5 vs 9.0 days, p < 0.001).

Conclusions

Our results highlight differences in preoperative health status between countries, which may arise due to different admission thresholds and access to surgery. In terms of quality of life, THR surgery is equally effective in both countries when performed on similar patients, but hospital stay is shorter in England.

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References

  1. Jenkins, P. J., Clement, N. D., Hamilton, D. F., Gaston, P., Patton, J. T., & Howie, C. R. (2013). Predicting the cost-effectiveness of total hip and knee replacement: a health economic analysis. Bone and Joint Journal, 95-B(1), 115–121.

    Article  CAS  PubMed  Google Scholar 

  2. Imamura, K., & Black, N. (1998). Outcome of total hip replacement in Japan and England. Comparison of two retrospective cohorts. International Journal of Technology Assessment in Health Care, 14(4), 762–773.

    Article  CAS  PubMed  Google Scholar 

  3. Gordon, M., Paulsen, A., Overgaard, S., Garellick, G., Pedersen, A. B., & Rolfson, O. (2013). Factors influencing health-related quality of life after total hip replacement—a comparison of data from the Swedish and Danish hip arthroplasty registers. BMC Musculoskeletal Disorders, 14, 316.

    Article  PubMed Central  PubMed  Google Scholar 

  4. OECD. (2012, 17 July 2013). Health at a glance Europe 2012. Retrieved January 17, 2014, from http://www.oecd.org/els/health-systems/HealthAtAGlanceEurope2012.pdf.

  5. Klauber, J., Geraedts, M., Friedrich, J., & Wasem, J. (2013). Krankenhaus-Report 2013 Mengendynamik: Mehr Menge, mehr Nutzen? Stuttgart: Schattauer.

    Google Scholar 

  6. Siciliani, L., Moran, V., & Borowitz, M. (2013). Measuring and comparing health care waiting times in OECD Countries, OECD Health Working paper No. 67. Retrieved February 2, 2014, from http://search.oecd.org/officialdocuments/publicdisplaydocumentpdf/?cote=DELSA/HEA/WD/HWP%282013%298&docLanguage=En.

  7. Garbuz, D. S., Xu, M., Duncan, C. P., Masri, B. A., & Sobolev, B. (2006). Delays worsen quality of life outcome of primary total hip arthroplasty. Clinical Orthopaedics and Related Research, 447, 79–84.

    Article  PubMed  Google Scholar 

  8. Vergara, I., Bilbao, A., Gonzalez, N., Escobar, A., & Quintana, J. (2011). Factors and consequences of waiting times for total hip arthroplasty. Clinical Orthopaedics and Related Research®, 469(5), 1413–1420.

    Article  Google Scholar 

  9. Hoogeboom, T. J., van den Ende, C. H. M., van der Sluis, G., Elings, J., Dronkers, J. J., Aiken, A. B., et al. (2009). The impact of waiting for total joint replacement on pain and functional status: A systematic review. Osteoarthritis and Cartilage, 17(11), 1420–1427.

    Article  CAS  PubMed  Google Scholar 

  10. Street, A., Gutacker, N., Bojke, C., Devlin, N., & Daidone, S. (2014). Variations in outcome and costs among NHS providers for common surgical procedures: econometric analyses of routinely collected data. Health Serv Deliv Res, 2(1).

  11. Dall, G. F., Ohly, N. E., Ballantyne, J. A., & Brenkel, I. J. (2009). The influence of pre-operative factors on the length of in-patient stay following primary total hip replacement for osteoarthritis: A multivariate analysis of 2302 patients. Journal of Bone and Joint Surgery British, 91(4), 434–440.

    Article  CAS  Google Scholar 

  12. Department of Health. (2010, 13 September 2013). Guidance on the routine collection of patient reported outcome measures (PROMs). Retrieved January 12, 2014, from http://webarchive.nationalarchives.gov.uk/20130107105354/http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_092625.pdf.

  13. Dolan, P. (1996). Modelling valuations for health states: The effect of duration. Health Policy, 38(3), 189–203.

    Article  CAS  PubMed  Google Scholar 

  14. Kind, P., Brooks, R., & Rabin, R. (2005). EQ-5D concepts and methods: A developmental history. Dordrecht: Springer.

    Book  Google Scholar 

  15. Austin, P. C. (2009). Balance diagnostics for comparing the distribution of baseline covariates between treatment groups in propensity-score matched samples. Statistics in Medicine, 28(25), 3083–3107.

    Article  PubMed Central  PubMed  Google Scholar 

  16. Ethgen, O., Bruyere, O., Richy, F., Dardennes, C., & Reginster, J. Y. (2004). Health-related quality of life in total hip and total knee arthroplasty: A qualitative and systematic review of the literature. The Journal of Bone and Joint Surgery, 86-A(5), 963–974.

    PubMed  Google Scholar 

  17. Biring, G. S., Masri, B. A., Greidanus, N. V., Duncan, C. P., & Garbuz, D. S. (2007). Predictors of quality of life outcomes after revision total hip replacement. Journal of Bone and Joint Surgery British, 89(11), 1446–1451.

    Article  CAS  Google Scholar 

  18. Husted, H., Holm, G., & Jacobsen, S. (2008). Predictors of length of stay and patient satisfaction after hip and knee replacement surgery: Fast-track experience in 712 patients. Acta Orthopaedica, 79(2), 168–173.

    Article  PubMed  Google Scholar 

  19. Bjorgul, K., Novicoff, W., & Saleh, K. (2010). Evaluating comorbidities in total hip and knee arthroplasty: available instruments. Journal of Orthopaedics and Traumatology, 11(4), 203–209.

    Article  PubMed Central  PubMed  Google Scholar 

  20. Rassen, J. A., Shelat, A. A., Myers, J., Glynn, R. J., Rothman, K. J., & Schneeweiss, S. (2012). One-to-many propensity score matching in cohort studies. Pharmacoepidemiology and Drug Safety, 21(Suppl 2), 69–80.

    Article  PubMed  Google Scholar 

  21. Austin, P. C. (2011). Optimal caliper widths for propensity-score matching when estimating differences in means and differences in proportions in observational studies. Pharmaceutical Statistics, 10(2), 150–161.

    Article  PubMed Central  PubMed  Google Scholar 

  22. Austin, P. C. (2009). Some methods of propensity-score matching had superior performance to others: Results of an empirical investigation and Monte Carlo simulations. Biometrical Journal, 51(1), 171–184.

    Article  PubMed  Google Scholar 

  23. Pearse, R. M., Moreno, R. P., Bauer, P., Pelosi, P., Metnitz, P., Spies, C., et al. (2012). Mortality after surgery in Europe: A 7 day cohort study. Lancet, 380(9847), 1059–1065.

    Article  PubMed Central  PubMed  Google Scholar 

  24. Stargardt, T. (2008). Health service costs in Europe: Cost and reimbursement of primary hip replacement in nine countries. Health Economics, 17(1 Suppl), S9–20.

    Article  PubMed  Google Scholar 

  25. Coleman, M. P., Quaresma, M., Berrino, F., Lutz, J. M., De Angelis, R., Capocaccia, R., et al. (2008). Cancer survival in five continents: A worldwide population-based study (CONCORD). The Lancet Oncology, 9(8), 730–756.

    Article  PubMed  Google Scholar 

  26. Institut für das Entgeltsystem im Krankenhaus (InEK). (2013). G-DRG Browser 2013; Datenveröffentlichung gem. § 21 KHEntgG. Retrieved February 11, 2014, from http://www.g-drg.de/cms/Datenveroeffentlichung_gem._21_KHEntgG.

  27. Gutacker, N., Bojke, C., Daidone, S., Devlin, N. J., Parkin, D., & Street, A. (2013). Truly inefficient or providing better quality of care? Analysing the relationship between risk-adjusted hospital costs and patients’ health outcomes. Health Economics, 22(8), 931–947.

    Article  PubMed  Google Scholar 

  28. Laudicella, M., Siciliani, L., & Cookson, R. (2012). Waiting times and socioeconomic status: Evidence from England. Social Science and Medicine, 74(9), 1331–1341.

    Article  PubMed  Google Scholar 

  29. Haanstra, T. M., van den Berg, T., Ostelo, R. W., Poolman, R. W., Jansma, E. P., Cuijpers, P., et al. (2012). Systematic review: Do patient expectations influence treatment outcomes in total knee and total hip arthroplasty? Health Quality Life Outcomes, 10, 152.

    Article  Google Scholar 

  30. Rice, N., Robone, S., & Smith, P. C. (2012). Vignettes and health systems responsiveness in cross-country comparative analyses. Journal of the Royal Statistical Society: Series A (Statistics in Society), 175(2), 337–369.

    Article  Google Scholar 

  31. Murray, C. J. L., Özaltin, E., Tandon, A., Salomon, J. A., Sadana, R., & Chatterji, S. (2003). Empirical evaluation of the anchoring vignette approach in health surveys (Chapter 30). In C. J. L. Murray & D. B. Evans (Eds.), Health systems performance assessment: Debates, methods and empiricism. Geneva: Word Health Organisation.

    Google Scholar 

  32. Bago d’Uva, T., Van Doorslaer, E., Lindeboom, M., & O’Donnell, O. (2008). Does reporting heterogeneity bias the measurement of health disparities? Health Economics, 17(3), 351–375.

    Article  PubMed  Google Scholar 

  33. Salomon, J. A., Tandon, A., & Murray, C. J. (2004). Comparability of self rated health: Cross sectional multi-country survey using anchoring vignettes. BMJ, 328(7434), 258.

    Article  PubMed Central  PubMed  Google Scholar 

  34. Jurges, H. (2007). True health vs response styles: Exploring cross-country differences in self-reported health. Health Economics, 16(2), 163–178.

    Article  PubMed  Google Scholar 

  35. Knies, S., Evers, S. M., Candel, M. J., Severens, J. L., & Ament, A. J. (2009). Utilities of the EQ-5D: transferable or not? Pharmacoeconomics, 27(9), 767–779.

    Article  PubMed  Google Scholar 

  36. Leidl, R., & Reitmeir, P. (2011). A value set for the EQ-5D based on experienced health states: Development and testing for the German population. Pharmacoeconomics, 29(6), 521–534.

    Article  PubMed  Google Scholar 

  37. Jansson, K. A., & Granath, F. (2011). Health-related quality of life (EQ-5D) before and after orthopedic surgery. Acta Orthopaedica, 82(1), 82–89.

    Article  PubMed Central  PubMed  Google Scholar 

  38. Pinedo-Villanueva, R. A., Turner, D., Judge, A., Raftery, J. P., & Arden, N. K. (2013). Mapping the Oxford hip score onto the EQ-5D utility index. Quality of Life Research, 22(3), 665–675.

    Article  PubMed  Google Scholar 

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Acknowledgments

The authors would like to thank Karen Bloor, Richard Cookson, Anne Mason, and Andrew Street as well as participants at the Health Economic seminar series at the Helmholtz Centre Munich for helpful comments and suggestions. Parts of this work were carried out while MV was visiting the Centre for Health Economics, York.

Conflict of interest

The authors do not have financial or other conflicts of interest that might bias this work.

Ethical standards

The German data were collected prospectively as part of a health state evaluation study carried out in a large orthopaedic hospital in Munich, Germany (‘Krankenhaus Barmherzige Brüder München’). Ethics approval for this study was granted by the Ethics committee of Klinikum rechts der Isar, Technical University Munich. The observational study was in accordance with the Helsinki Declaration of 1975, as revised in 2000. All patients gave their informed consent prior to their inclusion in the study. English HRQoL data were collected retrospectively as part of the routine national PROM survey and linked to routine inpatient data from the Hospital Episode Statistics dataset. No further ethics approval was required for secondary data analysis, and no patient-identifiable data were available. Data collection protocols were similar in both countries and followed guidance set out by the Department of Health in England.

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Authors and Affiliations

  1. Institute of Health Economics and Health Care Management (IGM), Helmholtz Zentrum München, German Research Center for Environmental Health, P.O. Box 1129, 85758, Neuherberg, Munich, Germany

    Matthias Vogl & Reiner Leidl

  2. Institute of Health Economics and Health Care Management, Munich Centre of Health Sciences, Munich School of Management, Ludwig-Maximilians-Universität München, Munich, Germany

    Matthias Vogl & Reiner Leidl

  3. Department of Orthopaedics and Trauma Surgery, Krankenhaus Barmherzige Brüder München, Romanstraße 93, 80639, Munich, Germany

    Werner Plötz

  4. Klinikum Rechts der Isar, Technical University Munich, Munich, Germany

    Werner Plötz

  5. Centre for Health Economics, University of York, Heslington, York, YO10 5DD, UK

    Nils Gutacker

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  1. Matthias Vogl
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Correspondence to Matthias Vogl.

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Vogl, M., Leidl, R., Plötz, W. et al. Comparison of pre- and post-operative health-related quality of life and length of stay after primary total hip replacement in matched English and German patient cohorts. Qual Life Res 24, 513–520 (2015). https://doi.org/10.1007/s11136-014-0782-9

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