The effect of negative randomized trials and surgeon volume on the rates of arthroscopy for patients with knee OA
Publication of 2 (negative) randomized clinical trials (RCTs) in 2002 and 2008 demonstrating inefficacy of arthroscopic debridement of the knee (ADK) for osteoarthritis, and a 2004 national non-coverage Medicare determination, have decreased overall ADK utilization. However, because of potentially f...
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| Format: | Article |
| Language: | English |
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Elsevier
2018-03-01
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| Series: | Contemporary Clinical Trials Communications |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2451865417300807 |
| _version_ | 1828861110469525504 |
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| author | Hassan M.K. Ghomrawi Robert G. Marx Ting-Jung Pan Matthew Conti Stephen Lyman |
| author_facet | Hassan M.K. Ghomrawi Robert G. Marx Ting-Jung Pan Matthew Conti Stephen Lyman |
| author_sort | Hassan M.K. Ghomrawi |
| collection | DOAJ |
| description | Publication of 2 (negative) randomized clinical trials (RCTs) in 2002 and 2008 demonstrating inefficacy of arthroscopic debridement of the knee (ADK) for osteoarthritis, and a 2004 national non-coverage Medicare determination, have decreased overall ADK utilization. However, because of potentially favorable outcomes associated with high volume, surgeons performing high arthroscopy volume may be slower to abandon performing ADK than would low volume surgeons. We examined the trends in ADKs performed by high and low volume surgeons before and after these 2 trials and the Medicare determination. New York state residents 40 years and older undergoing outpatient ADK from 1997 to 2010 were identified from a statewide database, and monthly population-based age and sex-adjusted ADK rates were calculated. We estimated the change in utilization trends over time, stratified by surgeon annual arthroscopy volume, for Medicare and non-Medicare patients. 1386 surgeons performed 29,658 ADKs during the study period, with the proportion performed by high volume surgeons increasing from 22% in 1997 to 66% in 2010. Overall monthly ADK rates declined from 2.4 to 1.3 per 100,000 population (45%) over the study period. Rates of ADK performed by high volume surgeons increased after the first RCT in the non-Medicare population and after the CMS decision in the Medicare population, and decreased after the second RCT. With more definitive evidence from the second negative trial, high volume surgeons performed less ADKs, suggesting that multiple RCTs with consistently negative results are needed to change practice of high volume surgeons. |
| first_indexed | 2024-12-13T02:54:07Z |
| format | Article |
| id | doaj.art-ac0a5a4e479c48378f5b3fe36acdf5a8 |
| institution | Directory Open Access Journal |
| issn | 2451-8654 |
| language | English |
| last_indexed | 2024-12-13T02:54:07Z |
| publishDate | 2018-03-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Contemporary Clinical Trials Communications |
| spelling | doaj.art-ac0a5a4e479c48378f5b3fe36acdf5a82022-12-22T00:02:00ZengElsevierContemporary Clinical Trials Communications2451-86542018-03-019C404410.1016/j.conctc.2017.11.011The effect of negative randomized trials and surgeon volume on the rates of arthroscopy for patients with knee OAHassan M.K. Ghomrawi0Robert G. Marx1Ting-Jung Pan2Matthew Conti3Stephen Lyman4Departments of Surgery and Pediatrics, Center for Healthcare Studies, Feinberg School of Medicine, Northwestern University, 633N St. Clair, Chicago, IL 60640, USADepartment of Orthopedics, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USAHealthcare Research Institute, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USADepartment of Orthopedics, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USAHealthcare Research Institute, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USAPublication of 2 (negative) randomized clinical trials (RCTs) in 2002 and 2008 demonstrating inefficacy of arthroscopic debridement of the knee (ADK) for osteoarthritis, and a 2004 national non-coverage Medicare determination, have decreased overall ADK utilization. However, because of potentially favorable outcomes associated with high volume, surgeons performing high arthroscopy volume may be slower to abandon performing ADK than would low volume surgeons. We examined the trends in ADKs performed by high and low volume surgeons before and after these 2 trials and the Medicare determination. New York state residents 40 years and older undergoing outpatient ADK from 1997 to 2010 were identified from a statewide database, and monthly population-based age and sex-adjusted ADK rates were calculated. We estimated the change in utilization trends over time, stratified by surgeon annual arthroscopy volume, for Medicare and non-Medicare patients. 1386 surgeons performed 29,658 ADKs during the study period, with the proportion performed by high volume surgeons increasing from 22% in 1997 to 66% in 2010. Overall monthly ADK rates declined from 2.4 to 1.3 per 100,000 population (45%) over the study period. Rates of ADK performed by high volume surgeons increased after the first RCT in the non-Medicare population and after the CMS decision in the Medicare population, and decreased after the second RCT. With more definitive evidence from the second negative trial, high volume surgeons performed less ADKs, suggesting that multiple RCTs with consistently negative results are needed to change practice of high volume surgeons.http://www.sciencedirect.com/science/article/pii/S2451865417300807KneeArthroscopyOsteoarthritisRCT effect |
| spellingShingle | Hassan M.K. Ghomrawi Robert G. Marx Ting-Jung Pan Matthew Conti Stephen Lyman The effect of negative randomized trials and surgeon volume on the rates of arthroscopy for patients with knee OA Contemporary Clinical Trials Communications Knee Arthroscopy Osteoarthritis RCT effect |
| title | The effect of negative randomized trials and surgeon volume on the rates of arthroscopy for patients with knee OA |
| title_full | The effect of negative randomized trials and surgeon volume on the rates of arthroscopy for patients with knee OA |
| title_fullStr | The effect of negative randomized trials and surgeon volume on the rates of arthroscopy for patients with knee OA |
| title_full_unstemmed | The effect of negative randomized trials and surgeon volume on the rates of arthroscopy for patients with knee OA |
| title_short | The effect of negative randomized trials and surgeon volume on the rates of arthroscopy for patients with knee OA |
| title_sort | effect of negative randomized trials and surgeon volume on the rates of arthroscopy for patients with knee oa |
| topic | Knee Arthroscopy Osteoarthritis RCT effect |
| url | http://www.sciencedirect.com/science/article/pii/S2451865417300807 |
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