Violation of expectations is correlated with satisfaction following hip arthroscopy

Socioeconomic Factors Including Patient Income, Education Level, and Health Insurance Influence Postoperative Secondary Surgery and Hospitalization Rates Following Hip Arthroscopy

PURPOSE

To evaluate a large cross-sectional sample of patients utilizing administrative database records and analyze the effects of income, insurance type, and education level on outcomes after hip arthroscopy, including 2-year revision surgery, conversion to total hip arthroplasty (THA), and 90-day hospitalizations.

METHODS

Current Procedural Terminology codes were used to query the PearlDiver Mariner database from October 2015 to January 2020 for patients undergoing hip arthroscopy with a minimum 2-year follow-up. Patients were categorized by mean family income in their zip code of residence (MFIR), health insurance type, and educational attainment in their zip code of residence (EAR). Two-year revision arthroscopy, conversion to THA, and 90-day hospital readmissions or emergency department (ED) visits were analyzed along socioeconomic strata.

RESULTS

Multivariate analysis of 33,326 patients revealed that patients with MFIR between $30,000 and $70,000 had lower odds of 2-year revision arthroscopy (odds ratio [OR], 0.63; P < .001), THA conversion (OR, 0.76; P = .050), and 90-day readmission (OR, 0.53; P = .007) compared to MFIR >$100,000. Compared to patients with commercial insurance, patients with Medicare had lower odds of revision arthroscopy (OR, 0.60; P = .035) and THA conversion (OR, 0.46, P < .001) but greater odds of 90-day readmission (OR, 1.74; P = .007). Patients with Medicaid had higher odds of 90-day ED visits (OR, 1.84; P < .001). Patients with low EAR had higher odds of revision arthroscopy (OR, 1.42; P = .005) and THA conversion (OR, 1.58; P = .002) compared to those with high EAR.

CONCLUSIONS

Following hip arthroscopy, patients residing in areas with lower mean family income were less likely to undergo reoperations and readmissions. Medicare patients showed lower reoperation but higher readmission odds, while Medicaid patients showed higher odds of ED visits. Additionally, higher educational attainment in the zip code of residence is protective against future reoperation.

LEVEL OF EVIDENCE

Level III, retrospective case series.

Editorial Commentary: Time to Recovery Varies After Hip Gluteus Repair: Patient Expectations Should Be Set Accordingly

Patients undergoing endoscopic gluteus medius and/or minimus repair with concomitant arthroscopic labral management have been reported to achieve excellent improvement in symptoms and outcome at as far as 5- to 10-year long-term follow-up. Although clinical outcomes at 2 years and onward are successful, few studies investigate how quickly patients improve after surgery. Most patients undergoing gluteus medius and/or minimus for predominantly partial-thickness tears achieve minimal clinically important differences as early as 6 months postoperatively, and a minimum of 1 year is needed for most patients to achieve a patient acceptable symptomatic state. From a patient counseling and satisfaction standpoint, time to recovery is of high importance.

Homogeneity in Surgical Series: Image Reporting to Improve Evidence

Good clinical practice guidelines are based on randomized controlled trials or clinical series; however, technical performance bias among surgical trials is under-assessed. The heterogeneity of technical performance within different treatment groups diminishes the level of evidence. Surgeon variability with different levels of experience-technical performance levels even after certification-influences surgical outcomes, especially in complex procedures. Technical performance quality correlates with the outcomes and costs and should be measured by image or video-photographic documentation of the surgeon's view field during the procedures. Such consecutive, completely documented, unedited observational data-in the form of intra-operative images and a complete set of eventual radiological images-improve the surgical series' homogeneity. Thereby, they might reflect reality and contribute towards making necessary changes for evidence-based surgery.