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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

Cumulative percent curve for proportion of patients receiving orthopaedic surgery by diagnostic groups at initial ambulatory visit to orthopaedic surgeons.
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pone-0065560-g002: Cumulative percent curve for proportion of patients receiving orthopaedic surgery by diagnostic groups at initial ambulatory visit to orthopaedic surgeons.

Mentions: Figure 2 shows the cumulative proportion of persons having orthopaedic surgery up to 18 months of the initial ambulatory visit in the index year by diagnostic group. After 18 months the curve of the trajectory had flattened suggesting that this time period had captured the majority of the surgeries. Sensitivity analyses showed that longer follow-up periods would not substantially increase the estimated proportion of patients with surgery. For example, at 18 months the proportion of patients with visits for osteoarthritis who had surgery was 35% and the projected proportion at 24 months was 36.9%.


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)

Cumulative percent curve for proportion of patients receiving orthopaedic surgery by diagnostic groups at initial ambulatory visit to orthopaedic surgeons.
© Copyright Policy
Related In: Results  -  Collection

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

pone-0065560-g002: Cumulative percent curve for proportion of patients receiving orthopaedic surgery by diagnostic groups at initial ambulatory visit to orthopaedic surgeons.
Mentions: Figure 2 shows the cumulative proportion of persons having orthopaedic surgery up to 18 months of the initial ambulatory visit in the index year by diagnostic group. After 18 months the curve of the trajectory had flattened suggesting that this time period had captured the majority of the surgeries. Sensitivity analyses showed that longer follow-up periods would not substantially increase the estimated proportion of patients with surgery. For example, at 18 months the proportion of patients with visits for osteoarthritis who had surgery was 35% and the projected proportion at 24 months was 36.9%.

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