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Surgery or consultation: a population-based cohort study of use of orthopaedic surgeon services.

Badley EM, Canizares M, MacKay C, Mahomed NN, Davis AM - PLoS ONE (2013)

Bottom Line: Regression analysis for each diagnostic group showed that younger patients were significantly more likely to be non-surgical than those aged 65+ years (age 0-24: OR 3.45 95%CI 3.33-3.57; age 25-44: OR 1.30 95%CI 1.27-1.33).The findings also suggest socioeconomic inequalities in access to orthopaedic care.This paper contributes to the development of evidence-based strategies to streamline access to surgery, and to develop models of care for non-surgical patients to optimize the use of scarce orthopaedic surgeon resources and to enhance the management of musculoskeletal disorders across the care continuum.

View Article: PubMed Central - PubMed

Affiliation: The Arthritis Community Research and Evaluation Unit, Division of Health Care and Outcomes Research, Toronto Western Research Institute, Toronto, Ontario, Canada. e.badley@utoronto.ca

ABSTRACT

Background: This population-based cohort study has the objective to understand the sociodemographic characteristics and health conditions of patients who do not receive surgery within 18 months following an ambulatory visit to an orthopaedic surgeon.

Methods: Administrative healthcare databases in Ontario, Canada were linked to identify all patients making an initial ambulatory visit to orthopaedic surgeons between October 1(st), 2004 and September 30(th), 2005. Logistic regression was used to examine predictors of not receiving surgery within 18 months.

Results: Of the 477,945 patients in the cohort 49% visited orthopaedic surgeons for injury, and 24% for arthritis. Overall, 79.3% did not receive surgery within 18 months of the initial visit, which varied somewhat by diagnosis at first visit (84.5% for injury and 73.0% for arthritis) with highest proportions in the 0-24 and 25-44 age groups. The distribution by income quintile of patients visiting was skewed towards higher incomes. Regression analysis for each diagnostic group showed that younger patients were significantly more likely to be non-surgical than those aged 65+ years (age 0-24: OR 3.45 95%CI 3.33-3.57; age 25-44: OR 1.30 95%CI 1.27-1.33). The odds of not getting surgery were significantly higher for women than men for injury and other conditions; the opposite was true for arthritis and bone conditions.

Conclusion: A substantial proportion of referrals were for expert diagnosis or advice on management and treatment. The findings also suggest socioeconomic inequalities in access to orthopaedic care. Further research is needed to investigate whether the high caseload of non-surgical cases affects waiting times to see a surgeon. This paper contributes to the development of evidence-based strategies to streamline access to surgery, and to develop models of care for non-surgical patients to optimize the use of scarce orthopaedic surgeon resources and to enhance the management of musculoskeletal disorders across the care continuum.

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Related in: MedlinePlus

Number of patients with ambulatory visits to orthopaedic surgeons and non-surgical patients by diagnostic groups at initial visit and age groups.
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pone-0065560-g001: Number of patients with ambulatory visits to orthopaedic surgeons and non-surgical patients by diagnostic groups at initial visit and age groups.

Mentions: Table 1 shows the characteristics of the cohort, the diagnosis at the initial ambulatory visit to an orthopaedic surgeon, and the proportion of non-surgical patients (patient who did not receive surgery within 18 months of the initial visit to orthopaedic surgeons). Overall, 79.3% of patients were non-surgical, with highest proportions in the 0–24 and 25–44 age groups. Patients aged less than 45 years made up to 40% of all patients with visits, and 45% of non-surgical patients. Almost half of all visits were for injury. Almost a quarter of patients visited for arthritis and related diagnoses, although these patients were mostly aged 45 years or older. The majority of patients visiting for ‘other conditions’ were in the 0–24 age group. Just over 10% of the cohort visited for multiple conditions. The distribution of patients with an ambulatory visit by income quintile was skewed towards higher incomes, but the opposite relationship was seen for non-surgical patients. The proportion of non-surgical patients varied somewhat by diagnostic group (Figure 1), and was highest for injury and particularly fractures (94%). This is not unexpected as we excluded likely emergency surgery from the cohort. The proportion of non-surgical patients was lowest for multiple diagnoses (63%) and osteoarthritis (65%). The latter was likely consultation for consideration of joint replacement surgery.


Surgery or consultation: a population-based cohort study of use of orthopaedic surgeon services.

Badley EM, Canizares M, MacKay C, Mahomed NN, Davis AM - PLoS ONE (2013)

Number of patients with ambulatory visits to orthopaedic surgeons and non-surgical patients by diagnostic groups at initial visit and age groups.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3672140&req=5

pone-0065560-g001: Number of patients with ambulatory visits to orthopaedic surgeons and non-surgical patients by diagnostic groups at initial visit and age groups.
Mentions: Table 1 shows the characteristics of the cohort, the diagnosis at the initial ambulatory visit to an orthopaedic surgeon, and the proportion of non-surgical patients (patient who did not receive surgery within 18 months of the initial visit to orthopaedic surgeons). Overall, 79.3% of patients were non-surgical, with highest proportions in the 0–24 and 25–44 age groups. Patients aged less than 45 years made up to 40% of all patients with visits, and 45% of non-surgical patients. Almost half of all visits were for injury. Almost a quarter of patients visited for arthritis and related diagnoses, although these patients were mostly aged 45 years or older. The majority of patients visiting for ‘other conditions’ were in the 0–24 age group. Just over 10% of the cohort visited for multiple conditions. The distribution of patients with an ambulatory visit by income quintile was skewed towards higher incomes, but the opposite relationship was seen for non-surgical patients. The proportion of non-surgical patients varied somewhat by diagnostic group (Figure 1), and was highest for injury and particularly fractures (94%). This is not unexpected as we excluded likely emergency surgery from the cohort. The proportion of non-surgical patients was lowest for multiple diagnoses (63%) and osteoarthritis (65%). The latter was likely consultation for consideration of joint replacement surgery.

Bottom Line: Regression analysis for each diagnostic group showed that younger patients were significantly more likely to be non-surgical than those aged 65+ years (age 0-24: OR 3.45 95%CI 3.33-3.57; age 25-44: OR 1.30 95%CI 1.27-1.33).The findings also suggest socioeconomic inequalities in access to orthopaedic care.This paper contributes to the development of evidence-based strategies to streamline access to surgery, and to develop models of care for non-surgical patients to optimize the use of scarce orthopaedic surgeon resources and to enhance the management of musculoskeletal disorders across the care continuum.

View Article: PubMed Central - PubMed

Affiliation: The Arthritis Community Research and Evaluation Unit, Division of Health Care and Outcomes Research, Toronto Western Research Institute, Toronto, Ontario, Canada. e.badley@utoronto.ca

ABSTRACT

Background: This population-based cohort study has the objective to understand the sociodemographic characteristics and health conditions of patients who do not receive surgery within 18 months following an ambulatory visit to an orthopaedic surgeon.

Methods: Administrative healthcare databases in Ontario, Canada were linked to identify all patients making an initial ambulatory visit to orthopaedic surgeons between October 1(st), 2004 and September 30(th), 2005. Logistic regression was used to examine predictors of not receiving surgery within 18 months.

Results: Of the 477,945 patients in the cohort 49% visited orthopaedic surgeons for injury, and 24% for arthritis. Overall, 79.3% did not receive surgery within 18 months of the initial visit, which varied somewhat by diagnosis at first visit (84.5% for injury and 73.0% for arthritis) with highest proportions in the 0-24 and 25-44 age groups. The distribution by income quintile of patients visiting was skewed towards higher incomes. Regression analysis for each diagnostic group showed that younger patients were significantly more likely to be non-surgical than those aged 65+ years (age 0-24: OR 3.45 95%CI 3.33-3.57; age 25-44: OR 1.30 95%CI 1.27-1.33). The odds of not getting surgery were significantly higher for women than men for injury and other conditions; the opposite was true for arthritis and bone conditions.

Conclusion: A substantial proportion of referrals were for expert diagnosis or advice on management and treatment. The findings also suggest socioeconomic inequalities in access to orthopaedic care. Further research is needed to investigate whether the high caseload of non-surgical cases affects waiting times to see a surgeon. This paper contributes to the development of evidence-based strategies to streamline access to surgery, and to develop models of care for non-surgical patients to optimize the use of scarce orthopaedic surgeon resources and to enhance the management of musculoskeletal disorders across the care continuum.

Show MeSH
Related in: MedlinePlus