Variation in patient-reported outcomes after total hip replacement across ten high-volume hospitals in Germany:...

International studies have demonstrated hospital-related variations in the outcomes of total hip replacement (THR) based on clinical outcome measures and Patient-Reported Outcomes (PROs). Therefore, this study explored hospital-related variations for THR based on PROs in Germany.

We performed a multicenter, prospective, longitudinal cohort study. Patients were recruited in ten high-volume hospitals in Lower Saxony, Germany (11/2019-2/2022). We measured the difference between the preoperative and 6-month postoperative absolute scores using the Oxford Hip Score (OHS). Therefore, we employed a multifactorial analysis of covariance model with OHS change from baseline as the dependent variable.

In total, 583 patients (65.54 ± 9.91 years; 62.1% female) were included in our analysis. The unadjusted mean OHS score increased from 21.61 ± 7.63 to 40.75 ± 8.10 points, thus indicating a change of 19.14 ± 9.58 points. Overall, 503 patients (86.3%) experienced a minimal important change (MIC) of at least 9 OHS points from the preoperative period to 6-months postoperative. The adjusted change in OHS points for participating hospitals varied between 13.41 and 17.99 OHS points. We found differences between the top-performing hospital and two hospitals (p < 0.05 each); however, those differences were shown to be below the minimal important difference (MID) of at least 5.22 OHS points.

We identified differences in the quality of care for THR among high-volume hospitals in Germany; however, those differences were below the MID threshold. Furthermore, both higher preoperative OHS scores and lower rates of pain relief usage was associated with lower change scores. We recommend studies to explore hospital-related clinically relevant variation for THR which also include low-volume hospitals and an evaluation of both MIC and MID thresholds in Germany.