The International Initiative to Measure Perceived Risk in Arthroplasty: The Results From a Multinational Survey

Area of Science:

• Orthopedic Surgery
• Health Services Research
• Health Economics

Background:

• Avoiding arthroplasty complications is crucial for surgeon reputation and reimbursement.
• Patients with comorbidities (obesity, diabetes) and socioeconomic challenges may face access barriers to elective arthroplasty.
• Healthcare systems increasingly score and compare outcomes, impacting financial incentives.

Purpose of the Study:

• To investigate surgeons' perceptions of medical and socioeconomic risk factors in patients undergoing total hip or knee arthroplasty.
• To explore how these perceptions influence patient access to arthroplasty across different healthcare systems.
• To identify potential disparities in access based on patient risk profiles.

Main Methods:

• Surveys were distributed to surgeons in 8 countries with varying payment and punitive models.
• Questions focused on surgeons' perceived risk associated with patient medical and socioeconomic factors.
• Primary analysis reported results from Canada, Ireland, and the United Kingdom.

Main Results:

• Healthcare systems ranged from universal (Canada) to private (India).
• Some systems implemented bundled payments and outcome data publication, while others did not.
• Perceptions of risk for age, body mass index, sex, and socioeconomic factors were consistent across systems, primarily driven by surgeon decisions.

Conclusions:

• Surgeons aim to optimize patient health, but evidence quality for risk factors, especially irreversible social ones, is variable.
• Experience-driven perceptions of risk influence access to arthroplasty across diverse healthcare environments.
• Enhanced risk-adjustment models for medical and socioeconomic factors are recommended to mitigate access disparities.