Determining the need for hip and knee arthroplasty: The role of clinical severity and patients' preferences

Citation
Ga. Hawker et al., Determining the need for hip and knee arthroplasty: The role of clinical severity and patients' preferences, MED CARE, 39(3), 2001, pp. 206-216
Citations number
48
Categorie Soggetti
Public Health & Health Care Science","Health Care Sciences & Services
Journal title
MEDICAL CARE
ISSN journal
00257079 → ACNP
Volume
39
Issue
3
Year of publication
2001
Pages
206 - 216
Database
ISI
SICI code
0025-7079(200103)39:3<206:DTNFHA>2.0.ZU;2-Z
Abstract
BACKGROUND. Area variation in the use of surgical interventions such as art hroplasty is viewed as concerning and inappropriate. OBJECTIVES. To determine whether area arthroplasty rates reflect patient-re lated demand factors, we estimated the need for and the willingness to unde rgo arthroplasty in a high and a low-use area of Ontario, Canada. RESEARCH DESIGN. Population-based mail and telephone survey. SUBJECTS. All adults aged greater than or equal to 55 years in a high (n = 21,925) and low (n = 26,293) arthroplasty use area. MEASURES. We determined arthritis severity and comorbidity with questionnai res, established the presence of arthritis with examination and radiographs , and evaluated willingness to have arthroplasty with interviews. Potential arthroplasty need was defined as severe arthritis, no absolute contraindic ation for surgery, and evidence of arthritis on examination and radiographs , Estimates of need were then adjusted for patients' willingness to undergo arthroplasty. RESULTS. Response rates were 72.0% for questionnaires and interviews. The p otential need for arthroplasty was 36.3/1,000 respondents in the high-rate area compared with 28.5/1,000 in the low-rate area (P<0.0001), Among indivi duals with potential need, only 14.9% in the high-rate area and 8.5% in the low-rate area were definitely willing to undergo arthroplasty (P=0.03), yi elding adjusted estimates of need of 5.4/1,000 and 2.4/1,000 in the high- a nd low-rate areas, respectively. CONCLUSIONS. Demonstrable need and willingness were greater in the high-rat e area, suggesting these factors explain in part the observed geographic ra te variations for this procedure. Among those with severe arthritis, no mor e than 15% were definitely willing to undergo arthroplasty, emphasizing the importance of considering both patients' preferences and surgical indicati ons when evaluating need and appropriateness of rates for surgery.