Health care costs after total knee arthroplasty for satisfied and dissatisfied patients

BACKGROUND: Evidence suggests that up to 21% of patients are dissatisfied after total knee arthroplasty (TKA), but the link between dissatisfaction and use of health care resources is unknown. The objective of this study was to compare costs after TKA between satisfied and dissatisfied patients. METHODS: This was a secondary analysis of a randomized clinical trial among patients who underwent primary TKA at our institution between 2015 and 2018. We estimated rates of satisfaction with pain relief and with return to function 1 year postoperatively. Patients prospectively reported use of health care resources 6 weeks, and 3, 6, 9 and 12 months after surgery. We compared costs between satisfied and dissatisfied patients from a public payer and a societal perspective. RESULTS: We included 156 patients in our analysis, of whom 42 (26.9%) were dissatisfied with pain, and 57 (36.5%) were dissatisfied with function. There was no significant difference in costs between patients dissatisfied with pain or function compared to satisfied patients from a health care payer perspective. From a societal perspective, patients dissatisfied with pain incurred a mean cost of $21 156.18, compared to $13 453.84 for satisfied patients (mean difference $7702.34, 95% confidence interval [CI] −89.43 to 15 494.11). Similarly, patients dissatisfied with function incurred a mean cost of $19 007.70, compared to $13 523.83 for those who were satisfied (mean difference $5483.87, 95% CI −526.34 to 11 494.10). CONCLUSION: Dissatisfied patients incurred greater costs than satisfied patients during the first year after TKA. The results justify further evaluation of factors contributing to patient satisfaction that may help to reduce the economic burden of TKA.