Measuring patient satisfaction with health care is an established indicator of quality of care largely used by hospital insurance companies and health policy makers to monitor quality of services. The use of this measure as a benchmark contributes to improved quality of care.
This study documents strong associations between inpatient satisfaction with care and 1-year HRQoL after surgery for bodily pain, mental health, social functioning, vitality and general health dimensions of the SF-36, whatever the preoperative HRQoL. These components predicting HRQoL suggest that actions to improve and optimize HRQoL could focus on these hospitalization features. Indeed, good communication by admission staff, physicians and nursing staff should be viewed as a core clinical skill.
As with other studies [6
], we also showed that all scores for HRQoL significantly increased after surgery, which confirms the positive effect of THR/TKR on self-perceived health status.
The association between these satisfaction dimensions and HRQoL one year after surgery suggests that health care professional support (real or perceived) is an important determinant of HRQoL after THR or TKR, but a causal relation is still difficult to establish. Some studies of older adults have shown that personality traits such as neuroticism, conscientiousness, extraversion, openness to experience, and agreeableness could influence HRQoL [30
], and could, although no study showed it, disturb the relation between the satisfaction with care and HRQoL after the surgery.
Patients can also develop coping strategies [32
]. Further research should investigate the contribution of such coping strategies on HRQoL evolution and whether they are independent or effect modifiers.
In accordance with some studies, our study revealed other factors associated with postoperative HRQoL. Patients with good self-perceived health status have shown high postoperative HRQoL [33
], but patients reporting poor preoperative HRQoL showed no improvement in HRQoL after surgery (i.e., no regression-to-the-mean phenomenon). As well, men have shown higher HRQoL after discharge than women in five HRQoL dimensions [4
]. Many studies have shown disparities in health status between the sexes [34
]. Men seem to benefit more from the intervention than do women, despite the high mortality rates for men. These differences can be explained largely by sex-specific variations in health behavior, acquired risk factors, and psychological and socioeconomic variables [35
]. HRQoL results have invariably confirmed women to have lower HRQoL scores than men [38
]. Patients with THR showed higher HRQoL than did patients with TKR [4
]. Although patients undergoing THR and TKR are hospitalized in the same surgical centers and are treated by the same medical and ancillary staff in each setting, patients with THR recover faster and show a better HRQoL than those with TKR [4
]. Our results also found age not associated with postoperative HRQoL, which confirms previous findings [43
]. Contrary to other studies showing that obesity and comorbities negatively influence SF-36 or WOMAC scores [4
], we did not observe any effect of these parameters on postoperative SF-36 scores. This disagreement could be explained by a difference in sample characteristics. Our study included fewer patients with severe or morbid obesity than did other studies: 75% of patients had a BMI ≤ 30, whereas in the most recent study [45
], more than 50% of patients had a BMI > 30. Consequently, we cannot exclude an effect of higher BMI on our results. As well, the lack of association with comorbidity could be explained by the low frequency of patients with comorbidities in our sample: almost 90% of our patients declared 0 or 1 comorbidities at inclusion.
This study has some limitations that could restrict the generalization of our findings. First, the mean length of hospital stay (13.5 days) was long as compared with practices reported in other countries. A short hospital stay is likely to influence the level of inpatient satisfaction, as was recently suggested [44
]. In our study, the length-of-stay distribution was rather narrow (see table ), so if length of stay affects HRQoL, this impact was of similar magnitude for all patients, which limits a potential impact of variability and subsequent association of satisfaction with care and other parameters and HRQoL. Second, the patients were recruited from several hospitals in one French region, so generalizability of results remains uncertain. Finally, if THR and TKR can improve HRQoL, the benefits may be time limited or dependent [46
]. We studied the impact of patient satisfaction with care on HRQoL one year after surgery; therefore, environmental factors and treating comorbidities and pain in locations other than those of the arthroplasty could have mid- and long-term effects on QoL of patients with THR or TKR and may modify the relation between immediate postoperative satisfaction and HRQoL after surgery.