Clinical Orthopaedics and Related Research®

, Volume 470, Issue 4, pp 1090–1105

Drivers of Surgery for the Degenerative Hip, Knee, and Spine: A Systematic Review

  • S. Samuel Bederman
  • Charles D. Rosen
  • Nitin N. Bhatia
  • P. Douglas Kiester
  • Ranjan Gupta
Symposium: Value Based Healthcare

DOI: 10.1007/s11999-011-2004-x

Cite this article as:
Bederman, S.S., Rosen, C.D., Bhatia, N.N. et al. Clin Orthop Relat Res (2012) 470: 1090. doi:10.1007/s11999-011-2004-x

Abstract

Background

Surgical treatment for degenerative conditions of the hip, knee, and spine has an impact on overall healthcare spending. Surgical rates have increased dramatically and considerable regional variation has been observed. The reasons behind these increasing rates and variation across regions have not been well elucidated.

Questions/purposes

We therefore identified demographic (D), social structure (SS), health belief (HB), personal (PR) and community resources (CR), and medical need (MN) factors that drive rates of hip, knee, and spine surgery.

Methods

We conducted a systematic review to include all observational, population-based studies that compared surgical rates with potential drivers (D, SS, HB, PR, CR, MN). We searched PubMed combining key words focusing on (1) disease and procedure; (2) study methodology; and (3) explanatory models. Independent investigators selected potentially eligible studies from abstract review and abstracted methodological and outcome data. From an initial search of 256 articles, we found 37 to be potentially eligible (kappa 0.86) but only 28 met all our inclusion criteria.

Results

Age, nonminority, insurance coverage, and surgeon enthusiasm all increased surgical rates. Rates of arthroplasty were higher for females with higher education, income, obesity, rurality, willingness to consider surgery, and prevalence of disease, whereas spinal rates increased with male gender, lower income, and the availability of advanced imaging.

Conclusions

Regional variation in these procedures exists because they are examples of preference-sensitive care. With strategies that may affect change in factors that are potentially modifiable by behavior or resources, extreme variation in rates may be reduced.

Copyright information

© The Association of Bone and Joint Surgeons® 2011

Authors and Affiliations

  • S. Samuel Bederman
    • 1
  • Charles D. Rosen
    • 1
  • Nitin N. Bhatia
    • 1
  • P. Douglas Kiester
    • 1
  • Ranjan Gupta
    • 1
  1. 1.Department of Orthopaedic SurgeryUniversity of California at IrvineOrangeUSA

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