PMID- 37343279
OWN - NLM
STAT- MEDLINE
DCOM- 20230725
LR  - 20230725
IS  - 1532-8406 (Electronic)
IS  - 0883-5403 (Linking)
VI  - 38
IP  - 7 Suppl 2
DP  - 2023 Jul
TI  - The Appropriateness of Preoperative Patient Reported Outcome Measures as an 
      Indication for Total Hip Arthroplasty.
PG  - S252-S257
LID - S0883-5403(22)00829-4 [pii]
LID - 10.1016/j.arth.2022.09.004 [doi]
AB  - BACKGROUND: While Medicare requires patient-reported outcome measures (PROMs) for 
      many quality programs, some commercial insurers have begun requiring preoperative 
      PROMs when determining patient eligibility for total hip arthroplasty (THA). 
      Concerns exist these data may be used to deny THA to patients above a specific 
      PROM score, but the optimal threshold is unknown. We aimed to evaluate outcomes 
      following THA based on theoretical PROM thresholds. METHODS: We retrospectively 
      analyzed 18,006 consecutive primary THA patients from 2016-2019. Hypothesized 
      preoperative Hip Disability and Osteoarthritis Outcome Score, Joint Replacement 
      (HOOS-JR) cutoffs of 40, 50, 60, and 70 points were used. Preoperative scores 
      below each threshold were considered "approved" surgery. Preoperative scores 
      above each threshold were considered "denied" surgery. In-hospital complications, 
      90-day readmissions, and discharge disposition were evaluated. HOOS-JR scores 
      were collected preoperatively and 1-year postoperatively. Minimum clinically 
      important difference (MCID) achievement was calculated using previously validated 
      anchor-based methods. RESULTS: Using preoperative HOOS-JR thresholds of 40, 50, 
      60, and 70 points, the percentage of patients who would have been denied surgery 
      was 70.4%, 43.2%, 20.3%, and 8.3%, respectively. For these denied patients, 
      1-year MCID achievement was 75.9%, 69.0%, 59.1%, and 42.1%, respectively. 
      In-hospital complication rates for approved patients were 3.3%, 3.0%, 2.8%, and 
      2.7%, while 90-day readmission rates were 5.1%, 4.4%, 4.2%, and 4.1%, 
      respectively. Approved patients had higher MCID achievement (P < .001) but higher 
      nonhome discharge (P = .01) and 90-day readmissions rates (P = .036) than denied 
      patients. CONCLUSION: Most patients achieved MCID at all theoretical PROM 
      thresholds with low complication and readmission rates. Setting preoperative PROM 
      thresholds for THA eligibility did not guarantee clinically successful outcomes.
CI  - Copyright (c) 2022. Published by Elsevier Inc.
FAU - Sutton, Ryan M
AU  - Sutton RM
AD  - Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, 
      Pennsylvania.
FAU - Baker, Colin M
AU  - Baker CM
AD  - Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, 
      Pennsylvania.
FAU - D'Amore, Taylor
AU  - D'Amore T
AD  - Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, 
      Pennsylvania.
FAU - Krueger, Chad A
AU  - Krueger CA
AD  - Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, 
      Pennsylvania.
FAU - Courtney, P Maxwell
AU  - Courtney PM
AD  - Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, 
      Pennsylvania.
LA  - eng
PT  - Journal Article
DEP - 20221108
PL  - United States
TA  - J Arthroplasty
JT  - The Journal of arthroplasty
JID - 8703515
SB  - IM
MH  - Humans
MH  - Aged
MH  - United States
MH  - *Arthroplasty, Replacement, Hip/adverse effects
MH  - Retrospective Studies
MH  - Treatment Outcome
MH  - Medicare
MH  - Patient Reported Outcome Measures
OTO - NOTNLM
OT  - HOOS-JR
OT  - MCID
OT  - eligibility
OT  - patient reported outcome measure
OT  - total hip arthroplasty
EDAT- 2023/06/21 19:15
MHDA- 2023/07/25 06:43
CRDT- 2023/06/21 17:28
PHST- 2022/05/17 00:00 [received]
PHST- 2022/08/30 00:00 [revised]
PHST- 2022/09/06 00:00 [accepted]
PHST- 2023/07/25 06:43 [medline]
PHST- 2023/06/21 19:15 [pubmed]
PHST- 2023/06/21 17:28 [entrez]
AID - S0883-5403(22)00829-4 [pii]
AID - 10.1016/j.arth.2022.09.004 [doi]
PST - ppublish
SO  - J Arthroplasty. 2023 Jul;38(7 Suppl 2):S252-S257. doi: 
      10.1016/j.arth.2022.09.004. Epub 2022 Nov 8.