From the Department of Orthopaedic Surgery, Hospital of the University of Pennsylvania (Dr. Scanlon, Dr. Perez, Dr. Sloan, Dr. Webb, and Dr. Sheth); the Drexel University College of Medicine (Dr. Yu); and the Department of Political Science, Temple University, Philadelphia, PA (Dr. Alvarez).
J Am Acad Orthop Surg Glob Res Rev. 2022 Jul 6;6(7). doi: 10.5435/JAAOSGlobal-D-22-00114. eCollection 2022 Jul 1.
Total joint arthroplasty (TJA) volume and the number of orthopaedic surgeons in the United States have increased in recent years, but local growth variation has not been studied. This study assesses recent changes in state-level distribution of orthopaedic surgeons in the United States and corresponding local trends in TJA volume.
Data from the National Inpatient Sample database (2000 to 2014) were reviewed. Urban versus rural setting and teaching versus nonteaching hospitals were identified among TJA procedures for comparison. Data from the American Academy of Orthopaedic Surgeons (2002 to 2016) detailing orthopaedic surgeon practice location were evaluated, and linear regression analysis was used to correlate state population data with orthopaedic surgeon density.
From 2000 to 2014, there was a 0.1% to 0.3% (P < 0.01) annual decrease in the proportion of TJA procedures conducted in rural hospitals. No notable change was observed in the proportion of TJA procedures conducted at urban teaching versus nonteaching hospitals. Linear regression analysis demonstrated that decreased state population was associated with higher orthopaedic surgeon density (adjusted R2 = 0.114, P < 0.01). States with a higher percentage of population living in rural areas had a lower density of orthopaedic surgeons in the South region and a higher density of orthopaedic surgeons in the remainder of the county.
Less populated, rural states have a higher density of orthopaedic surgeons than states with increased population and less rural areas. Although TJA volume has increased since 2000, the proportion of TJA procedures conducted at rural hospitals has decreased. No change was found in the proportion of TJA procedures conducted at urban teaching versus nonteaching hospitals. This may indicate that more patients living in rural areas are seeking TJA care in urban centers. Future studies are needed to confirm this and ensure that patients living in rural areas have appropriate access to TJA care.
近年来，美国全关节置换术（TJA）的数量和骨科医生的数量有所增加，但尚未研究当地的增长变化。本研究评估了美国州级骨科医生分布的最新变化以及 TJA 数量的相应当地趋势。
审查了国家住院患者样本数据库（2000 年至 2014 年）的数据。在 TJA 手术中，根据城市与农村环境以及教学与非教学医院进行了比较。评估了美国骨科协会（2002 年至 2016 年）详细说明骨科医生执业地点的数据，并使用线性回归分析将州人口数据与骨科医生密度相关联。
从 2000 年到 2014 年，在农村医院进行的 TJA 手术比例每年下降 0.1%至 0.3%（P < 0.01）。在城市教学与非教学医院进行的 TJA 手术比例没有明显变化。线性回归分析表明，州人口减少与骨科医生密度增加相关（调整后的 R2 = 0.114，P < 0.01）。人口中居住在农村地区比例较高的州，其南部地区的骨科医生密度较低，而其余地区的骨科医生密度较高。
人口较少的农村州的骨科医生密度高于人口增加和农村地区较少的州。尽管自 2000 年以来 TJA 数量有所增加，但在农村医院进行的 TJA 手术比例有所下降。在城市教学与非教学医院进行的 TJA 手术比例没有变化。这可能表明，更多居住在农村地区的患者正在城市中心寻求 TJA 护理。需要进一步研究来证实这一点，并确保居住在农村地区的患者能够获得适当的 TJA 护理。
