Regional variation in hip and knee arthroplasty rates in Switzerland: A population-based small area analysis.
<h4>Background</h4>Compared to other OECD countries, Switzerland has the highest rates of hip (HA) and knee arthroplasty (KA).<h4>Objective</h4>We assessed the regional variation in HA/KA rates and potential determinants of variation in Switzerland.<h4>Methods</h4>...
| Main Authors: | , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Public Library of Science (PLoS)
2020-01-01
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| Series: | PLoS ONE |
| Online Access: | https://doi.org/10.1371/journal.pone.0238287 |
| _version_ | 1818725666655305728 |
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| author | Maria M Wertli Judith M Schlapbach Alan G Haynes Claudia Scheuter Sabrina N Jegerlehner Radoslaw Panczak Arnaud Chiolero Nicolas Rodondi Drahomir Aujesky |
| author_facet | Maria M Wertli Judith M Schlapbach Alan G Haynes Claudia Scheuter Sabrina N Jegerlehner Radoslaw Panczak Arnaud Chiolero Nicolas Rodondi Drahomir Aujesky |
| author_sort | Maria M Wertli |
| collection | DOAJ |
| description | <h4>Background</h4>Compared to other OECD countries, Switzerland has the highest rates of hip (HA) and knee arthroplasty (KA).<h4>Objective</h4>We assessed the regional variation in HA/KA rates and potential determinants of variation in Switzerland.<h4>Methods</h4>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.<h4>Results</h4>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.<h4>Conclusion</h4>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. |
| first_indexed | 2024-12-17T21:45:56Z |
| format | Article |
| id | doaj.art-a1bc24c29bbd4b888a1f65d3ae668ab2 |
| institution | Directory Open Access Journal |
| issn | 1932-6203 |
| language | English |
| last_indexed | 2024-12-17T21:45:56Z |
| publishDate | 2020-01-01 |
| publisher | Public Library of Science (PLoS) |
| record_format | Article |
| series | PLoS ONE |
| spelling | doaj.art-a1bc24c29bbd4b888a1f65d3ae668ab22022-12-21T21:31:27ZengPublic Library of Science (PLoS)PLoS ONE1932-62032020-01-01159e023828710.1371/journal.pone.0238287Regional variation in hip and knee arthroplasty rates in Switzerland: A population-based small area analysis.Maria M WertliJudith M SchlapbachAlan G HaynesClaudia ScheuterSabrina N JegerlehnerRadoslaw PanczakArnaud ChioleroNicolas RodondiDrahomir Aujesky<h4>Background</h4>Compared to other OECD countries, Switzerland has the highest rates of hip (HA) and knee arthroplasty (KA).<h4>Objective</h4>We assessed the regional variation in HA/KA rates and potential determinants of variation in Switzerland.<h4>Methods</h4>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.<h4>Results</h4>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.<h4>Conclusion</h4>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.https://doi.org/10.1371/journal.pone.0238287 |
| spellingShingle | Maria M Wertli Judith M Schlapbach Alan G Haynes Claudia Scheuter Sabrina N Jegerlehner Radoslaw Panczak Arnaud Chiolero Nicolas Rodondi Drahomir Aujesky Regional variation in hip and knee arthroplasty rates in Switzerland: A population-based small area analysis. PLoS ONE |
| title | Regional variation in hip and knee arthroplasty rates in Switzerland: A population-based small area analysis. |
| title_full | Regional variation in hip and knee arthroplasty rates in Switzerland: A population-based small area analysis. |
| title_fullStr | Regional variation in hip and knee arthroplasty rates in Switzerland: A population-based small area analysis. |
| title_full_unstemmed | Regional variation in hip and knee arthroplasty rates in Switzerland: A population-based small area analysis. |
| title_short | Regional variation in hip and knee arthroplasty rates in Switzerland: A population-based small area analysis. |
| title_sort | regional variation in hip and knee arthroplasty rates in switzerland a population based small area analysis |
| url | https://doi.org/10.1371/journal.pone.0238287 |
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