Regional variation in hip and knee arthroplasty rates in Switzerland: A population-based small area analysis.
PLoS One
; 15(9): e0238287, 2020.
Article
en En
| MEDLINE
| ID: mdl-32956363
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.
Texto completo:
1
Colección:
01-internacional
Base de datos:
MEDLINE
Asunto principal:
Factores Socioeconómicos
/
Análisis de Área Pequeña
/
Evaluación de Resultado en la Atención de Salud
/
Artroplastia de Reemplazo de Cadera
/
Artroplastia de Reemplazo de Rodilla
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Atención a la Salud
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Fracturas de Cadera
Tipo de estudio:
Prognostic_studies
/
Risk_factors_studies
Aspecto:
Determinantes_sociais_saude
Límite:
Adolescent
/
Adult
/
Aged
/
Aged80
/
Female
/
Humans
/
Male
/
Middle aged
País/Región como asunto:
Europa
Idioma:
En
Revista:
PLoS One
Asunto de la revista:
CIENCIA
/
MEDICINA
Año:
2020
Tipo del documento:
Article
País de afiliación:
Suiza
Pais de publicación:
Estados Unidos