Healthcare Atlas ServicesHelse Førde Health Trust Førde , Postboks 1000, Helse Førde, Førde 6807, Norway.
Helgeland Hospital, Mo i Rana, Norway Center for Clinical Documentation and Evaluation (SKDE), Tromsø, Norway Department of Clinical Medicine, Faculty of Health Sciences, UiT the Arctic University of Norway, Tromsø, Norway.
Scand J Surg. 2022 Dec;111(4):92-98. doi: 10.1177/14574969221118488. Epub 2022 Sep 14.
Standardized surgery rates for common orthopedic procedures vary across geographical areas in Norway. We explored 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.
The present study is a cross-sectional population-based study of hospital referral areas in Norway. We included adult admissions for arthroscopy for degenerative knee disease, arthroplasty for osteoarthritis of the knee and hip, surgical treatment for hip fracture, and decompression with/without fusion for lumbar disk herniation and lumbar spinal stenosis in 2012-2016. Variation in age and sex standardized rates was estimated using extremal quotients, coefficients of variation, and systematic components of variation (SCV). Associations between surgery rates and the socioeconomic factors urbanity, unemployment, low-income, high level of education, mortality, and number of surgeons and hospitals were explored with linear regression analyses.
Knee arthroscopy showed highest level of variation (SCV 10.3) and decreased in numbers. Variation was considerable for spine surgery (SCV 3.8-4.9), moderate to low for arthroplasty procedures (SCV 0.8-2.6), and small for hip fracture surgery (SCV 0.2). Higher rates of knee arthroscopy were associated with more orthopedic surgeons (adjusted coefficient 24.8, 95% confidence interval (CI): 2.7-47.0), and less urban population (adjusted coefficient -13.3, 95% CI: -25.4 to -1.2). Higher spine surgery rates were associated with more hospitals (adjusted coefficient 22.4, 95% CI: 4.6-40.2), more urban population (adjusted coefficient 2.1, 95% CI: 0.4-3.8), and lower mortality (adjusted coefficient -192.6, 95% CI: -384.2 to -1.1). Rates for arthroplasty and hip fracture surgery were not associated with supply/demand factors included.
Arthroscopy for degenerative knee disease decreased in line with guidelines, but showed high variation of surgery rates. Socioeconomic factors included in this study did not explain geographical variation in orthopedic surgery.
在挪威，常见骨科手术的标准化手术率因地理位置而异。我们探讨了与公共资助医疗保健中的需求和供应相关的区域因素是否与六种常见骨科手术的手术率的地理差异有关。
本研究是一项针对挪威医院转诊区的横断面人群研究。我们纳入了 2012-2016 年退行性膝关节疾病关节镜检查、膝关节和髋关节骨关节炎关节置换、髋部骨折手术治疗以及腰椎间盘突出症和腰椎椎管狭窄症减压术（伴或不伴融合）的成年住院患者。使用极值比、变异系数和系统变异分量（SCV）来估计年龄和性别标准化率的差异。使用线性回归分析探讨手术率与社会经济因素（城市化程度、失业率、低收入、高教育水平、死亡率以及外科医生和医院数量）之间的关系。
膝关节镜检查显示出最高的变异水平（SCV 为 10.3），并且数量减少。脊柱手术的变异性相当大（SCV 为 3.8-4.9），关节置换手术的变异性为中度至低度（SCV 为 0.8-2.6），髋部骨折手术的变异性较小（SCV 为 0.2）。膝关节镜检查率较高与更多的骨科医生相关（调整后的系数为 24.8，95%置信区间（CI）：2.7-47.0），与较少的城市人口相关（调整后的系数为-13.3，95%CI：-25.4 至-1.2）。较高的脊柱手术率与更多的医院相关（调整后的系数为 22.4，95%CI：4.6-40.2），与更多的城市人口相关（调整后的系数为 2.1，95%CI：0.4-3.8），与较低的死亡率相关（调整后的系数为-192.6，95%CI：-384.2 至-1.1）。关节置换和髋部骨折手术率与纳入的供需因素无关。
退行性膝关节疾病的关节镜检查符合指南，但手术率差异很大。本研究纳入的社会经济因素不能解释骨科手术的地理差异。
