title: Comparison of pre- and post-operative health-related quality of life and length of stay after primary total hip replacement in matched English and German patient cohorts.
abstract: OBJECTIVE
  We compare pre- and post-operative health-related quality of life (HRQoL) and length of stay after total hip replacement (THR) in matched German and English patient cohorts to test for differences in admission thresholds, clinical effectiveness and resource utilisation between the healthcare systems.
  
  
  METHODS
  German data (n = 271) were collected in a large orthopaedic hospital in Munich, Germany; English data (n = 26,254) were collected as part of the national patient-reported outcome measures programme. HRQoL was measured using the EuroQoL-5D instrument. Propensity score matching was used to construct two patient cohorts that are comparable in terms of preoperative patient characteristics.
  
  
  RESULTS
  Before matching, patients in England showed lower preoperative EQ-5D scores (0.35 vs 0.52, p < 0.001) and experienced a larger improvement in HRQoL (0.43 vs 0.33, p < 0.001) than German patients. Patients in the German cohort were more likely to report no or only moderate problems with mobility and pain preoperatively than their English counterparts. After matching, improvements in HRQoL were comparable (0.32 vs 0.33, p = 0.638); post-operative scores were slightly higher in the German cohort (0.82 vs 0.85, p = 0.585). Length of stay was substantially lower in England than in Germany (4.5 vs 9.0 days, p < 0.001).
  
  
  CONCLUSIONS
  Our results highlight differences in preoperative health status between countries, which may arise due to different admission thresholds and access to surgery. In terms of quality of life, THR surgery is equally effective in both countries when performed on similar patients, but hospital stay is shorter in England.
authors.affiliation: Institute of Health Economics and Health Care Management (IGM), Helmholtz Zentrum München, German Research Center for Environmental Health, P.O. Box 1129, 85758, Neuherberg, Munich, Germany, matthias.vogl@helmholtz-muenchen.de.
authors.forename: Matthias
authors.initials: M
authors.lastname: Vogl
authors.forename: Reiner
authors.initials: R
authors.lastname: Leidl
authors.forename: Werner
authors.initials: W
authors.lastname: Plötz
authors.forename: Nils
authors.initials: N
authors.lastname: Gutacker
mesh_terms: D000368:Aged; D019644:Arthroplasty, Replacement, Hip / Q000523:psychology; D015331:Cohort Studies; D004739:England; D005260:Female; D005858:Germany; D006295:Health Resources / Q000706:statistics & numerical data; D006304:Health Status; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D057234:Preoperative Period; D011788:Quality of Life; D011795:Surveys and Questionnaires