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

Wertli, Maria M.; Schlapbach, Judith M.; Haynes, Alan G.; Scheuter, Claudia; Jegerlehner, Sabrina N.; Panczak, Radoslaw; Chiolero, Arnaud; Rodondi, Nicolas; Aujesky, Drahomir (2020). Regional variation in hip and knee arthroplasty rates in Switzerland: A population-based small area analysis. PLoS ONE, 15(9), e0238287. Public Library of Science 10.1371/journal.pone.0238287

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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.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of General Internal Medicine (DAIM) > Clinic of General Internal Medicine > Centre of Competence for General Internal Medicine
04 Faculty of Medicine > Medical Education > Institute of General Practice and Primary Care (BIHAM)
04 Faculty of Medicine > Pre-clinic Human Medicine > Institute of Social and Preventive Medicine (ISPM)
04 Faculty of Medicine > Pre-clinic Human Medicine > CTU Bern
04 Faculty of Medicine > Department of General Internal Medicine (DAIM) > Clinic of General Internal Medicine

UniBE Contributor:

Wertli, Maria Monika; Haynes, Alan; Scheuter, Claudia; Panczak, Radoslaw; Chiolero, Arnaud; Rodondi, Nicolas and Aujesky, Drahomir

Subjects:

600 Technology > 610 Medicine & health
300 Social sciences, sociology & anthropology > 360 Social problems & social services

ISSN:

1932-6203

Publisher:

Public Library of Science

Funders:

[4] Swiss National Science Foundation

Language:

English

Submitter:

Andrea Flükiger-Flückiger

Date Deposited:

15 Oct 2020 20:33

Last Modified:

15 Oct 2020 21:05

Publisher DOI:

10.1371/journal.pone.0238287

PubMed ID:

32956363

BORIS DOI:

10.7892/boris.146863

URI:

https://boris.unibe.ch/id/eprint/146863

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