Patient, Hospital, and Outcome Factors Associated with Attaining Substantial Clinical Benefit Following Primary Total Hip Arthroplasty.

Abstract

Background: Centers for Medicare and Medicaid Services (CMS) began mandating at least 50% institutional compliance of patient-reported outcome-based performance measures (PRO-PMs) for Medicare fee-for-service patients undergoing inpatient, elective total hip arthroplasty (THA). The PRO-PM is calculated to represent the proportion of patients meeting or exceeding the substantial clinic benefit (SCB) threshold between pre- and postoperative patient-reported outcome measures (PROMs). The purpose of this study was to evaluate demographics, operative variables, hospital outcomes, and PROMs among two groups of patients following primary THA: those achieving SCB and those who did not reach this threshold.

Methods: A retrospective review was performed of patients undergoing primary THA at a single large academic center between January 2015 and November 2024. Demographic, operative, and outcome variables were compared between patients meeting and not meeting SCB. Multivariable analysis was performed to identify risk factors for failure to achieve SCB.

Results: A total of 1,257 patients were included; 54% were women, and 88% met SCB. Few differences between groups in demographics and complications were observed. Patients not meeting SCB more often had a contralateral hip arthroplasty (P < 0.001), government insurance (P = 0.011), and a higher preoperative HOOS JR interval score (q < 0.001); these associations remained significant on multivariable analysis. At postoperative time points, functional PROMs were lower and pain scores were higher among patients not achieving SCB.

Conclusions: The institution of this new CMS mandate puts renewed attention on the SCB metric. Our results indicate the difficulty in collecting PROMs in accordance with this mandate. Patients not meeting SCB following THA demonstrated few differences in demographics or hospital course, yet exhibited a significant difference in PROMs profile. Future studies are needed to elucidate the underlying causes of observed differences, and essential for equitable arthroplasty care.