Health care costs after total knee arthroplasty for satisfied and dissatisfied patients

Background: Evidence suggests that up to 21% of patients are dissatisfied after total knee arthroplasty (TKA), but the link between dissatisfaction and use of health care resources is unknown. The objective of this study was to compare costs after TKA between satisfied and dissatisfied patients. Methods: This was a secondary analysis of a randomized clinical trial among patients who underwent primary TKA at our institution between 2015 and 2018. We estimated rates of satisfaction with pain relief and with return to function 1 year postoperatively. Patients prospectively reported use of health care resources 6 weeks, and 3, 6, 9 and 12 months after surgery. We compared costs between satisfied and dissatisfed patients from a public payer and a societal perspective. Results: We included 156 patients in our analysis, of whom 42 (26.9%) were dissatisfed with pain, and 57 (36.5%) were dissatisfied with function. There was no signifcant difference in costs between patients dissatisfied with pain or function compared to satisfied patients from a health care payer perspective. From a societal perspective, patients dissatisfied with pain incurred a mean cost of $21 156.18, compared to $13 453.84 for satisfied patients (mean difference $7702.34, 95% confidence interval [CI] -89.43 to 15 494.11). Similarly, patients dissatisfied with function incurred a mean cost of $19 007.70, compared to $13 523.83 for those who were satisfied (mean difference $5483.87, 95% CI -526.34 to 11 494.10). Conclusion: Dissatisfied patients incurred greater costs than satisfied patients during the first year after TKA. The results justify further evaluation of factors contributing to patient satisfaction that may help to reduce the economic burden of TKA. Contexte : Selon des donnees probantes, jusqu'a 21 % des patients sont insatisfaits a la suite d'une arthroplastie totale du genou (ATG), mais le lien entre l'insatisfaction et le recours a des ressources de soins de sante est inconnu. L'objectif de cette etude etait de comparer les couts a la suite d'une ATG chez les patients satisfaits et les patients insatisfaits. Methodes : Il s'agissait d'une analyse secondaire d'un essai clinique randomise chez des patients ayant subi une ATG primaire dans notre etablissement entre 2015 et 2018. Nous avons estime les taux de satisfaction quant au soulagement de la douleur et a la reprise des activites 1 an apres l'operation. Les patients ont signale de facon prospective le recours a des ressources de soins de sante 6 semaines, 3 mois, 6 mois, 9 mois et 12 mois apres l'intervention chirurgicale. Nous avons compare les couts chez les patients satisfaits et les patients insatisfaits du point de vue societal et selon la perspective du payeur public. Resultats : Au total, 156 patients ont ete inclus dans notre analyse, dont 42 (26,9 %) etaient insatisfaits quant au soulagement de la douleur et 57 (36,5 %) quant a la reprise des activites. Selon la perspective du payeur de soins de sante, il n'y avait aucune difference significative entre les couts chez les patients satisfaits et ceux chez les patients insatisfaits concernant le soulagement de la douleur ou la reprise des activites. Du point de vue societal, les patients insatisfaits quant au soulagement de la douleur ont assume un cout moyen de 21 156,18 $, comparativement a 13 453,84 $ chez les patients satisfaits (difference moyenne 7702,34 $; intervalle de confance [IC] de 95 % -89,43 a 15 494,11). De meme, les patients insatisfaits quant a la reprise des activites ont assume un cout moyen de 19 007,70 $, comparativement a 13 523,83 $ chez les patients satisfaits (difference moyenne 5483,87 $; IC de 95 % -526,34 a 11 494,10). Conclusion : Les patients insatisfaits ont assume des couts plus eleves que les patients satisfaits durant la premiere annee qui a suivi l'ATG. Les resultats obtenus justifent une evaluation plus poussee des facteurs de satisfaction des patients, qui peuvent aider a reduire le fardeau economique de l'ATG.
Total knee arthroplasty (TKA) is an effective surgical intervention for patients with advanced osteoarthritis, providing reduced pain, and improved function and quality of life. Despite these benefits, historical evidence suggests [...]