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Regional variation in hip and knee arthroplasty rates in Switzerland: A population-based small area analysis.

ABSTRACT: BACKGROUND:Compared to other OECD countries, Switzerland has the highest rates of hip (HA) and knee arthroplasty (KA). OBJECTIVE:We assessed the regional variation in HA/KA rates and potential determinants of variation in Switzerland. METHODS:We conducted a population-based analysis using discharge data from all Swiss hospitals during 2013-2016. We derived hospital service areas (HSAs) by analyzing patient flows. We calculated age-/sex-standardized procedure rates and measures of variation (the extremal quotient [EQ, highest divided by lowest rate] and the systemic component of variation [SCV]). We estimated the reduction in variance of HA/KA rates across HSAs in multilevel regression models, with incremental adjustment for procedure year, age, sex, language, urbanization, socioeconomic factors, burden of disease, and the number of orthopedic surgeons. RESULTS:Overall, 69,578 HA and 69,899 KA from 55 HSAs were analyzed. The mean age-/sex-standardized HA rate was 265 (range 179-342) and KA rate was 256 (range 186-378) per 100,000 persons and increased over time. The EQ was 1.9 for HA and 2.5 for KA. The SCV was 2.0 for HA and 2.2 for KA, indicating a low variation across HSAs. When adjusted for procedure year and demographic, cultural, and sociodemographic factors, the models explained 75% of the variance in HA and 63% in KA across Swiss HSAs. CONCLUSION:Switzerland has high HA/KA rates with a modest regional variation, suggesting that the threshold to perform HA/KA may be uniformly low across regions. One third of the variation remained unexplained and may, at least in part, represent differing physician beliefs and attitudes towards joint arthroplasty.

SUBMITTER: Wertli MM

PROVIDER: S-EPMC7505431 | biostudies-literature | 2020

REPOSITORIES: biostudies-literature

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Regional variation in hip and knee arthroplasty rates in Switzerland: A population-based small area analysis.

Wertli Maria M MM Schlapbach Judith M JM Haynes Alan G AG Scheuter Claudia C Jegerlehner Sabrina N SN Panczak Radoslaw R Chiolero Arnaud A Rodondi Nicolas N Aujesky Drahomir D

PloS one 20200921 9

<h4>Background</h4>Compared to other OECD countries, Switzerland has the highest rates of hip (HA) and knee arthroplasty (KA).<h4>Objective</h4>We assessed the regional variation in HA/KA rates and potential determinants of variation in Switzerland.<h4>Methods</h4>We conducted a population-based analysis using discharge data from all Swiss hospitals during 2013-2016. We derived hospital service areas (HSAs) by analyzing patient flows. We calculated age-/sex-standardized procedure rates and measu ...[more]

PMID: 32956363

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Project description:Importance:Rates of total knee arthroplasty vary widely across the United States. Whether this variation is associated with differences in patient characteristics or physician practice is unknown. Objectives:To determine regional variations in rates of total knee arthroplasty after accounting for the prevalence of knee arthritis and other potentially associated patient risk factors and to assess the correlation of these variations with measures of access to care and surgical indications. Design, Setting, and Participants:This retrospective national cohort study used Medicare data on more than 24 million deidentified beneficiaries annually from 2011 to 2015. Individuals included had fee-for-service coverage, were 65 to 89 years of age, and resided in 1 of 306 health referral regions. Data were analyzed from September 13, 2018, to August 15, 2019. Main Outcomes and Measures:Rate of primary total knee arthroplasty indexed to the national rate using observed to expected ratios. The expected numbers of arthroplasty procedures were derived from estimates based on beneficiaries' demographic and clinical characteristics. Observed to expected ratios were confounded by race/ethnicity; thus race/ethnicity-stratified analyses were conducted. Results:In 2011, there were 218?282 total knee arthroplasty procedures among 24?583?706 white Medicare beneficiaries (mean [SD] age 74.2 [6.9] years; 54.6% women). The rate of arthroplasty during the study period (5 years) was 9.3 per 1000 person-years. Adjustment for clinical characteristics reduced the spread in observed to expected ratios among regions by 29% compared with adjustment for age and sex alone. However, substantial variation remained, with observed to expected ratios that ranged from 0.61 in Newark, New Jersey, to 1.82 in Idaho Falls, Idaho. High ratios were primarily present in the upper Midwest, Great Plains, and Mountain West regions. Higher ratios were associated with regions where beneficiaries had fewer outpatient visits (Spearman correlation [r], -0.64; 95% CI, -0.70 to -0.56) and with regions having more surgeons per capita who performed knee arthroplasty (r?=?0.27; 95% CI, 0.16-0.37). Higher ratios were associated with higher rates of arthroplasty procedures among beneficiaries with dementia (r?=?0.36; 95% CI, 0.25-0.46), peripheral vascular disease (r?=?0.52; 95% CI, 0.42-0.61), and skin ulcers (r?=?0.43; 95% CI, 0.32-0.53), which are relative contraindications to arthroplasty. Conclusions and Relevance:Substantial regional variation in rates of total knee arthroplasty remained after adjustment for patient characteristics. Coexistence of high observed to expected ratios and high rates among patients at greater surgical risk suggested overuse of knee arthroplasty in some regions.

Dataset Information

Regional variation in hip and knee arthroplasty rates in Switzerland: A population-based small area analysis.

Publications

Regional variation in hip and knee arthroplasty rates in Switzerland: A population-based small area analysis.

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