Shifting primary and revision hip- and knee arthroplasty from public to private hospitals in the Netherlands: implications for case mix, and outcome. An exploratory analysis based on the LROI. PROMs and travel distance

Starting date: August 31st 2023

WP Zijlstra, B van Dooren, P Bos, R Peters, W Schreurs, L van Steenbergen, E de Visser, M Brinkman

Research proposal abstract
In recent years, a shift of primary THA and TKA procedures from public hospitals towards private (‘ZBC’) hospitals is seen in the Netherlands [1]. This shift has been driven by several factors, including longer waiting lists in public hospitals [2] as well as advertisement by private hospitals. In addition, the Covid-19 pandemic had an additional negative impact on the waiting lists in public hospitals as Covid care affected the surgical volume in these public hospitals [3]. As we started to emerge from the pandemic and more surgical capacity is available in the public hospitals, it is important to study the current situation of how and where the care for total hip- and knee arthroplasty patients is performed. Also, for capacity estimations it is important if these larger volumes will be performed in private hospitals in the future. Factual information of quality of care, trends over time and possible differences in patient population and subsequent outcome between private- and public hospitals is lacking. Therefore, the aim of this study is to explore the shift of primary hip- and knee arthroplasty in private- and public hospitals in the Netherlands, using data from the Dutch Arthroplasty Register. We aim to provide a comprehensive overview of the procedures performed and their characteristics in both type of hospitals. Specifically, we aim to describe patient characteristics (over time), describe the risk of revision and patient reported outcomes using PROMs, in both types of hospitals between 2014 and 2022.