Geographical variation in musculoskeletal surgical care in public hospitals in Ireland: a repeated cross-sectional study

Abstract

ObjectiveTo examine the extent of geographical variation across musculoskeletal surgical procedures and associated factors in Ireland.DesignRepeated cross-sectional study.Setting36 public hospitals in Ireland.ParticipantsAdult admissions for hip fracture, hip and knee replacement, knee arthroscopy and lumbar spine interventions over 5 years (2012–2016).Primary outcome measureStandardised discharge rate (SDR).AnalysisAge and sex SDRs were calculated for 21 geographical areas. Extremal quotients, coefficients of variation and systematic components of variance were calculated. Linear regression analyses were conducted exploring the relationship between SDRs and year, unemployment, % urban population, number of referral hospitals, % on waiting lists>6 months and % with private health insurance for each procedure.ResultsAcross 36 public hospitals, n=102 756 admissions were included. Hip fracture repair showed very low variation. Elective hip and knee procedures showed high variation in particular years, while variation for lumbar interventions was very high. Knee arthroscopy rates decreased over time. Higher unemployment was associated with knee and hip replacement rates and urban areas had lower hip replacement rates. Spinal procedure rates were associated with a lower number of referral hospitals in a region and spinal injection rates were associated with shorter waiting lists. A higher proportion of patients having private health insurance was associated with higher rates of hip and knee replacement and lumbar spinal procedures.ConclusionsVariation and factors associated with SDRs for publicly funded hip and knee procedures are consistent with similar international research in this field. Further research should explore reasons for high rates of spinal injections and the impact of private practice on musculoskeletal procedure variation.

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

“…A similar pattern of decrease has been reported in other European countries, as well as in the US (5,25,26).…”

“…As surgical treatment of a hip fracture is considered both effective and necessary, we did not expect to nd any association with supply or demand related factors. The small amount of variation in hip fracture surgery is in line with other reports (5,31,32) and variation is generally considered to re ect the relatively small differences in incidence.…”

“…Studies from Ireland, Korea and the UK (5,7,27) report an increase in knee arthroplasty with deprivation. Rates for knee and hip arthroplasty have also been associated with numbers of surgeons, hospital capacity (7,27,28), and socioeconomic factors (28, 29).…”

“…The number of orthopedic surgical procedures per population, i.e. the surgery rate, vary for all common orthopedic procedures in Norway (1,2,3,4), as well as in most other countries (5,6,7,8,9). For some procedures, like hip fracture repair where the e cacy of the treatment and positive outcomes are not disputed, the variation is small and likely to describe differences in incidence.…”

Behandlingsrater for ryggkirurgi i Norge og Helse Nord 2014–18

“…Behandlingsratene i Norge er mye lavere enn ratene for tilsvarende ryggkirurgi i USA, der det i 2012 ble utført 149 lette og 144 tunge ryggoperasjoner per 100 000 innbyggere (4). I England var raten for alle ryggoperasjoner 49 per 100 000 innbyggere i 2013, og i Irland var behandlingsraten stabil på omlag 26 per 100 000 innbyggere per år i perioden 2012-16 (9,15). Den engelske studien angir ikke om operasjoner ved private sykehus ble inkludert, mens den irske kun analyserte data fra offentlige sykehus.…”