Linear regression analysis of Hospital Episode Statistics predicts a large increase in demand for elective hand surgery in England

Abstract

SummaryIntroductionWe integrated two factors, demographic population shifts and changes in prevalence of disease, to predict future trends in demand for hand surgery in England, to facilitate workforce planning.MethodsWe analysed Hospital Episode Statistics data for Dupuytren's disease, carpal tunnel syndrome, cubital tunnel syndrome, and trigger finger from 1998 to 2011. Using linear regression, we estimated trends in both diagnosis and surgery until 2030. We integrated this regression with age specific population data from the Office for National Statistics in order to estimate how this will contribute to a change in workload over time.ResultsThere has been a significant increase in both absolute numbers of diagnoses and surgery for all four conditions. Combined with future population data, we calculate that the total operative burden for these four conditions will increase from 87,582 in 2011 to 170,166 (95% confidence interval 144,517–195,353) in 2030.DiscussionThe prevalence of these diseases in the ageing population, and increasing prevalence of predisposing factors such as obesity and diabetes, may account for the predicted increase in workload. The most cost effective treatments must be sought, which requires high quality clinical trials. Our methodology can be applied to other sub-specialties to help anticipate the need for future service provision.

Prognostic factors for response to treatment by corticosteroid injection or surgery in carpal tunnel syndrome (palms study): A prospective multicenter cohort study

“…Furthermore, surgery is more costly than conservative measures. In the United Kingdom, 52,806 carpal tunnel releases or revisions were undertaken in 2011 at a cost of £42 million, whereas, in the United States, 500,000 CTS operations are performed annually at a cost of $2 billion per year…”

“…10,11 Furthermore, surgery is more costly than conservative measures. In the United Kingdom, 52,806 carpal tunnel releases or revisions were undertaken in 2011 at a cost of £42 million, 12 whereas, in the United States, 500,000 CTS operations are performed annually at a cost of $2 billion per year. 13 Some healthcare systems use restrictive policies in which surgery is offered only in cases in which symptoms persist for more than 3 months after initial conservative therapy or in which the patient suffers from significant functional impairment or has a neurological deficit.…”

Study protocol: A multi-centre, double blind, randomised, placebo-controlled, parallel group, phase II trial (RIDD) to determine the efficacy of intra-nodular injection of anti-TNF to control disease progression in early Dupuytren’s disease, with an embedded dose response study.

“…Dupuytren’s disease is a very common age dependent fibrotic disorder of the hand and the number of patients requiring treatment in the UK is expected to increase by 50% by 2030 50 . The mainstay of treatment remains surgical excision but requires prolonged post-operative hand therapy, may be associated with a relatively high complication rate and is not cost effective 51, 52 .…”

Can we use routinely collected hospital and GP data for epidemiological study of common hand conditions? A UK Biobank based validation project

“…Females are more commonly affected than males, and incidence increases with age [2][3][4]. A study of trends in surgical treatment noted a significant increase in the number of procedures being undertaken in the UK, with this increasing trend predicted to continue in an aging population [5].…”