Variation in Utilization of Postoperative Rehabilitation After Total Hip Arthroplasty in Japan

Shosuke Ohtera; Genta Kato; Hiroaki Ueshima; Yukiko Mori; Yuka Nakatani; Takeo Nakayama; Tomohiro Kuroda

doi:10.1016/j.apmr.2023.10.007

Variation in Utilization of Postoperative Rehabilitation After Total Hip Arthroplasty in Japan

Arch Phys Med Rehabil. 2023 Oct 26:S0003-9993(23)00600-7. doi: 10.1016/j.apmr.2023.10.007. Online ahead of print.

Authors

Shosuke Ohtera¹, Genta Kato², Hiroaki Ueshima³, Yukiko Mori⁴, Yuka Nakatani⁵, Takeo Nakayama⁵, Tomohiro Kuroda⁴

Affiliations

¹ Division of Medical Information Technology and Administration Planning, Kyoto University Hospital, Kyoto, Japan; Center for Outcomes Research and Economic Evaluation for Health, National Institute of Public Health, Saitama, Japan; Department of Health Economics, Center for Gerontology and Social Science, Research Institute, National Center for Geriatrics and Gerontology, Aichi, Japan.
² Solutions Center for Health Insurance Claims, Kyoto University Hospital, Kyoto, Japan. Electronic address: qq9f8hn9@kuhp.kyoto-u.ac.jp.
³ Division of Medical Information Technology and Administration Planning, Kyoto University Hospital, Kyoto, Japan; Center for Innovative Research and Education in Data Science, Institute for Liberal Arts and Science, Kyoto University, Kyoto, Japan.
⁴ Division of Medical Information Technology and Administration Planning, Kyoto University Hospital, Kyoto, Japan.
⁵ Department of Health Informatics, Kyoto University School of Public Health, Kyoto, Japan.

PMID: 37890550
DOI: 10.1016/j.apmr.2023.10.007

Abstract

Objective: The use of rehabilitation after arthroplasty in Japan is unknown. We aimed to identify utilization of postoperative rehabilitation after total hip arthroplasty (THA) and to explore the factors associated with rehabilitation usage.

Design: A retrospective cohort study using the National Database of Health Insurance Claims and Specific Health Checkups of Japan (NDB).

Setting: Hospitals nationwide.

Participants: Patients aged >40 years who underwent primary THA between 2017 and 2018 (N=51,332).

Interventions: Not applicable.

Main outcome measures: The proportion of patients who underwent postoperative rehabilitation and the number of rehabilitation days were also calculated. Patient demographic characteristics, hospital case volumes, and regions associated with continuing postoperative rehabilitation were analyzed using a Cox proportional hazards model.

Results: Eligible patients were selected from 3033 hospitals, of whom 41,192 (80%) were women. Of these, 94% used inpatient rehabilitation, and 20% received outpatient rehabilitation. The mean durations of rehabilitation were 47±72 days for inpatient and 195±109 days for outpatient, respectively. Large-scale hospitals performing more than 200 procedures annually had the shortest duration of inpatient rehabilitation (36-65 days) and the longest duration of outpatient rehabilitation (220-109 days) compared with smaller hospitals. The regression model consistently showed that rehabilitation continued longer at hospitals with over 200 patients per year (HR 0.96, 95% CI 0.93-0.99, P<.007).

Conclusion: The Japanese health care system provided higher access to inpatient rehabilitation after THA than other countries. One limitation of this study is that long-term care insurance data were not analyzed. However, outpatient rehabilitation vary according to hospital case volume. Further research is needed to determine the causes of variation in rehabilitation use and the effect of variation on patient outcomes.

Keywords: Health equity; Health services; Postoperative care; Rehabilitation; Routinely collected health data; Total hip arthroplasty.