Patient-reported outcomes in orthopedic surgery: Enhancing care quality and reducing socioeconomic inequality

This thesis used Patient-Reported Outcome Measure (PROM) data to identify opportunities for enhanced clinical practice in orthopedic surgery, while deepening our understanding of their application in this field. A systematic review demonstrated the effectiveness of PROMs in routine clinical settings, such as shared decision-making and monitoring tools. Empirical studies using Dutch national registry data revealed that deprived total hip and knee arthroplasty (THA, TKA) patients experienced worse preoperative health and recovery trajectories compared to affluent patients. Conversely, A U.S. Medicare claims study found that variations in peripheral nerve block use were primarily driven by clinical and hospital characteristics, rather than socioeconomic factors. Another study found minimal impact of the COVID-19 pandemic and lockdown on PROMs of Dutch THA and TKA patients. Methodological challenges were addressed, including an equivalence study of adult and youth quality of life (EQ-5D) instruments in adolescents with scoliosis and issues related to measurement error of PROMs. The thesis concludes that further research on inequalities and targeted interventions to reduce these differences is needed to improve orthopedic practice. Additionally, ongoing efforts to overcome the methodological challenges are essential for maximizing the impact of PROMs on patient-centered care.