A comparative health care inventory for primary hip arthroplasty between Germany versus the Netherlands. Is there a downside effect to fast-track surgery with regard to patient satisfaction and functional outcome?

Abstract

Background: Treatment and rehabilitation protocol for hip arthroplasty differs between Germany and the Netherlands. The Dutch system promotes fast-track surgery whereas in Germany conventional care is provided with a longer hospital stay including rehabilitation. Clinical outcome, patient satisfaction and costs in both treatment protocols were compared in a prospective setup. Material and methods: This prospective cohort study included patients allocated for primary THA in 3 German and 1 Dutch hospital in the border region. Patient-reported outcome scores (PROMS) were measured pre- and postoperatively at 6 and 12 months including the Oxford Hip Score, SF12 survey, visual analogue scale for satisfaction and pain. Length of hospitalisation and availability of postoperative rehabilitation were recorded. In addition, a total cost estimation was calculated using health insurers data. Results: A total of 360 consecutive patients were included; 175 THA in Germany compared to 185 THA in the Netherlands. No cross-border healthcare was encountered in both cohorts. Mean length of hospitalisation was 11.3 (range 6–23) days in Germany, compared to 4.4 (range 3–25) days in the Netherlands. In Germany 92% of the patients was discharged with inpatient (72%) or outpatient (20%) rehabilitation, compared to 21% with only inpatient rehabilitation in the Netherlands. No significant differences were measured regarding the PROMS and patient satisfaction between both countries. Due to profound differences in health care financing only a global cost estimation could be made and no major differences were encountered. Conclusion: Germany and the Netherlands both offer highly protocolled care for THA with comparable functional outcome and patient satisfaction with treatment after 12 months. Despite the length of hospitalisation in Germany is significantly longer including a more intensive rehabilitation programme, no significant differences were recorded regarding functional outcome nor patient satisfaction compared to fast-track surgery performed in the Netherlands.

Are functional outcomes and early pain affected by discharge on the day of surgery following total hip and knee arthroplasty?

“…Few studies have compared pain scores between outpatients and inpatients following THA and TKA during the first postoperative days, but other studies have done so with regards to the first postoperative weeks and months. These studies have found similar pain levels between inpatients and outpatients after THA and TKA (Schotanus et al 2017, Füssenich et al 2020. Schotanus et al (2017) found that 6 weeks after TKA both inpatients and outpatients had mean NRS pain scores of 2.6.…”

Improvement of Negative Psychological Stress Response in Elderly Patients With Femoral Neck Fracture by Integrated High-Quality Nursing Model of Medical Care

“…Although the operation has a good effect on femoral neck fracture, because most of the patients are elderly, they have poor psychological endurance, slow reaction, unclear language expression, lack of understanding of diseases and operations knowledge, and worry too much that the fracture site will return to normal after the operation, which will easily lead to negative psychology such as anxiety and depression, etc. If they are not dealt with in time and effectively, it will affect the postoperative recovery of patients ( 15 , 16 ). This study showed that after treatment, the SDS and SAS scores of the patients in the observation group were significantly lower than those in the control group after treatment.…”

Utilisation of outpatient physiotherapy in patients following total knee arthroplasty – a systematic review

“…Even higher proportions are observed in Germany, where the acute care of TKA or THA patients is usually followed by 3 weeks of inpatient rehabilitation [ 45 ]. For example, Füssenich et al reported that 72% of THA patients underwent inpatient rehabilitation following surgery [ 46 ].…”

“…In the United States, the above-mentioned rapid review showed a median of 34.1% being discharged home with supervision, but at a wide range from 0.6 to 44.2% [ 42 ]. In Germany, Füssenich et al observed that 20% of THA patients receive outpatient rehabilitation for 3 weeks, where they have 4–6 h of therapeutic interventions per day [ 46 ]. Outpatient PT can also be used alongside or after specific rehabilitation services.…”