Offering patients the opportunity to choose their hospital for total knee replacement: impact on satisfaction with the surgery.
OBJECTIVE
To describe the extent to which patients were offered a choice between 2 or more hospitals for total knee replacement (TKR); to examine the association between having a choice of hospital for TKR and satisfaction with the surgery; and to identify population groups less likely to be offered a choice.


METHODS
We studied a population-based sample of 932 Medicare beneficiaries who underwent elective TKR in 2000. We surveyed patients about their participation in choosing a hospital and their satisfaction with surgery. We examined whether lack of hospital choice influenced satisfaction with surgery after adjusting for age, sex, preoperative function, and socioeconomic status.


RESULTS
Among 932 TKR recipients (mean age 74 years, 67% women), more than half (53%) reported having a lack of hospital choice. After adjusting for socioeconomic status, patients reporting lack of choice were approximately twice as likely to be dissatisfied with the results of surgery as patients who reported choosing among 2 or more hospitals for TKR (odds ratio [OR] 2.09, 95% confidence interval [95% CI] 1.13-3.87). Results of logistic regression revealed that patients reporting lack of choice were more likely to be women (OR 1.52, 95% CI 1.14-2.04), >80 years of age (as compared with 65-70 years; OR 1.63, 95% CI 1.03-2.57), living in suburban areas (OR 1.68, 95% CI 1.23-2.30), nonwhite (OR 1.57, 95% CI 0.86-2.87), and were less likely to have TKR performed by a high-volume surgeon (OR 0.71, 95% CI 0.53-0.96).


CONCLUSIONS
More than half of the patients did not have a choice in selecting the hospital where they had TKR. Patients reporting lack of choice were more likely to be dissatisfied with surgery. Interventions to address preferences for hospital may improve satisfaction with care for patients with advanced knee arthritis.
Losina
Elena
E
Boston University School of Public Health, and Robert Brigham Arthritis and Musculoskeletal Clinical Research Center, MA 02118, USA. lenal@bu.edu
Plerhoples
Timothy
T
Fossel
Anne H
AH
Mahomed
Nizar N
NN
Barrett
Jane
J
Creel
Alisha H
AH
Wright
Elizabeth A
EA
Katz
Jeffrey N
JN
D000368:Aged; D000369:Aged, 80 and over; D019645:Arthroplasty, Replacement, Knee / Q000523:psychology* / Q000706:statistics & numerical data; D002755:Choice Behavior; D005260:Female; D015438:Health Behavior / Q000208:ethnology; D006761:Hospitals / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D010358:Patient Participation; D017060:Patient Satisfaction / Q000208:ethnology / Q000706:statistics & numerical data; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology; D044465:White People / Q000208:ethnology