What factors are important to patients when considering a revision total knee replacement in a network model of care? An exploratory qualitative analysis.

BACKGROUND: Revision knee replacement carries significant implications for healthcare systems both clinically and financially. Rationalising revision knee replacement surgery in fewer, more experienced hospitals and their surgeons has the promise of reduced reoperation rates and lower costs. However, this may create additional logistic and financial challenges for patients. This study aimed to explore the factors important to patients in the decision-making process for revision knee replacement surgery in a regional network model of care. METHODS: An exploratory analysis was performed using semi structured interviews with 7 patients (median age 75 years: range 61 to 86) with experience of revision knee replacement either as a previous patient, family member or lay member of a research group. Interviews were audio-recorded, transcribed and de-identified and analysed using a descriptive thematic analysis. RESULTS: Four themes were important in participants' accounts: importance of returning to normality; faith in surgical expertise; travel for major surgery; travel for shorter hospital visits. CONCLUSIONS: Our findings suggest that the theory of travelling further for better results is universally acknowledged by patients, but that age, mobility and dependency often place restrictions on accessibility. Utilising local services for shorter hospital visits before and after revision surgery is an attractive option for patients hoping to benefit from surgical expertise.