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
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.