Geographical variations in the use of three elective surgical procedures in the elderly

1
Geographical variations in the use of three
elective surgical procedures in the elderly
J Jacques1, D Gillain1, J Petermans2, P Kolh1, P
Gillet3 1Medico-Economic Informations Department
(Simé), University Hospital (CHU) of Liège
Belgium 2Geriatric department CHU Liège Belgium
3 University of Liège

• Objective To study the incidence of three three
  surgical procedures in the old person Total Hip
  Replacement (THR), Total Knee Replacement (TKR)
  and Cataract Intervention and to assess the
  geographical disparities in Belgium
• Methodology Based on administrative data of all
  hospital admissions between 1997 and 2002 in
  Belgium, a perimeter of definition was built by
  combination of criteria of inclusion (APR-DRG,
  ICD-9-CM procedures) and exclusion (diagnosis and
  procedure ICD-9-CM codes). A standardized
  admission ratio (SAR) for each of the 589 belgian
  municipalities was obtained (method of indirect
  standardization). In a second time, multiple
  regression is used to explain the SAR by district
  by several explanatory variables reflecting the
  demand and the supply of care. To observe the
  effect of the different variables, we proceed in
  two steps firstly, a regression model where the
  explanatory variables are a set of demand
  variables secondly, introducing into the
  equation supply variables.
• Results The multivariate linear regression
  model shows, for cataract, that demand and supply
  variables explain each of them approximately 10
  of geographical disparities. Comorbidity is not a
  significant variable of the explanatory model.
  Income and educational level, in the demand
  model, and living alone, in the complete model,
  are significant. In the supply variables, we
  notice that high substitution rate to day
  hospital may reflect a degree of attractiveness
  of the procedure. Finally, physician density is
  not decisive.
• In the cases of TKR and THR, the developed model
  explains moderately variation between the SAR by
  district. Less than 10 of the variability of
  standardized rates of intervention can be
  explained by selected variables. Regarding
  supply, the density of orthopedists and of
  hospital beds are associated with high levels of
  TKR. However, in the literature, there is no
  evidence to explain the meaning of this
  correlation. Thus, for certain authors, a greater
  offer would make it possible to meet a request
  which is not besides assured (underuse
  hypothesis). In England, 5 to 7 of population
  over 65 years presents a need of TKR which is not
  met. On the contrary, for others, this best
  accessibility of the offer would imply an induced
  demand (overuse hypothesis). Yong PF, et al.
  Inequalities in access to knee joint replacements
  for people in need. Ann.Rheum.Dis.
  200463(11)1483
• Conclusions Geographical disparities are
  observed in Belgium for the three procedures.
  Multiple regressions used explained only a little
  part of those.

Cataract
Total knee replacement (TKR)
Total hip replacement (THR)
Contact jessica.jacques_at_chu.ulg.ac.be