Geographical Variation In Common Orthopedic Procedures In Norway: A Cross-Sectional Population Based Study

Abstract

BackgroundStandardised surgery rates for common orthopedic procedures vary across geographical areas in Norway. The aim in this study is to explore whether area-level factors related to demand and supply in publicly funded healthcare are associated with geographical variation in surgery rates for six common orthopedic procedures. MethodsCross-sectional population based study of the 19 hospital referral areas in Norway. Adult admissions for arthroscopy for degenerative knee disease, arthroplasty for osteoarthritis of the knee and hip, surgical treatment for hip fracture, and decompression with or without fusion for lumbar disc herniation and lumbar spinal stenosis over 5 years (2012-2016) were included. Extremal quotients, coefficients of variation and systematic components of variance were used to estimate variation in age and sex standardised surgery rates. Linear regression analyses were conducted to explore the association between standardised surgery rates and proportion of population in urban areas, unemployment, proportion of persons living in low-income households, proportion of persons with a high level of education, and mortality. ResultsArthroscopy for degenerative knee disease showed the highest level of variation and the number of arthroscopies decreased during the period. There was considerable variation in procedures for lumbar disc herniation and lumbar spinal stenosis, moderate to low variation for arthroplasty for osteoarthritis of the knee and hip, and least variation in surgical treatment for hip fracture. Association between surgery rates and socioeconomic and supply factors were weak for arthroscopy for degenerative knee disease and decompression for lumbar disc herniation and spinal stenosis. Standardised surgery rates for arthroplasty for osteoarthritis of the knee and hip, and surgical treatment for hip fracture were not associated with the supply and demand factors included in this study.ConclusionsVariation in surgery rates were particularly high for arthroscopy for degenerative knee disease, and these rates decreased considerably during the five-year period. Factors reflecting socioeconomic circumstances, health and supply have a weak association to orthopedic surgery rates at an area-level. Whether this reflects the equity of universal health care services, or if area-level factors are not detailed enough to detect an existing association is being explored in two ongoing Norwegian studies.