title: Satisfaction with joint replacement in public versus private hospitals: a cohort study.
abstract: BACKGROUND
  In Australia, the majority of total knee and hip replacement surgeries occur in the private sector. Outcome-based research needs to be inclusive of this sector if the findings are intended to reflect the broader picture. This study compares outcomes up to 1 year post knee and hip replacement between patients treated in the public and private sectors.
  
  
  METHODS
  A prospective, observational study was performed in four high-volume joint replacement centres: two public, two private. Experienced orthopaedic surgeons contributed via their public and private practices. Knee and hip patients were recruited preoperatively. Self-reported questionnaires were completed preoperatively and at 6 and 12 months post-operatively. The primary outcome was satisfaction with surgery. Secondary outcomes included Oxford score, and SF-36 physical and mental component summary scores. Regression modelling was performed to adjust for potential confounders.
  
  
  RESULTS
  Three hundred and thirty-one patients (184 public, 147 private; 215 knees, 116 hips) were recruited, with 6- and 12-month follow-up rates of 95% and 89%, respectively. Satisfaction rates were high in both public and private patients (approximately 90%) at 6 and 12 months, but private patients were less likely to be satisfied after adjusting for the strong effect of patient expectation. For both hip and knee cohorts, no between-sector differences were found in either the magnitude or rate of improvement in Oxford score or quality of life post-operatively.
  
  
  CONCLUSIONS
  Joint replacement outcomes are similar for patients treated in public and private hospitals. Surgeons should manage patient expectation prior to surgery, particularly in private patients.
authors: South West Sydney Clinical School, University of New South Wales, Sydney, New South Wales, Australia. sam.adie@gmail.com
authors: Sam
authors: S
authors: Adie
authors: Alan
authors: A
authors: Dao
authors: Ian A
authors: IA
authors: Harris
authors: Justine M
authors: JM
authors: Naylor
authors: Rajat
authors: R
authors: Mittal
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip; D019645:Arthroplasty, Replacement, Knee; D015331:Cohort Studies; D005260:Female; D016304:Hospitals, Private; D006779:Hospitals, Public; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009517:New South Wales; D015207:Osteoarthritis, Hip / Q000601:surgery*; D020370:Osteoarthritis, Knee / Q000601:surgery*; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D011446:Prospective Studies; D057566:Self Report; D016896:Treatment Outcome