Key result
A 10% increase in surgical rates was associated with only a 0.3% decline in pre-operative PROM scores for knee replacement (P<0.05) and varicose vein surgery (P<0.001).
Why the study?
Do higher rates of surgery reduce patients' pre-operative clinical need and post-operative benefit in NHS-funded patients?
Observational
Yes
Do higher rates of surgery reduce patients' pre-operative clinical need and post-operative benefit in NHS-funded patients?
p-value: p=<0.001
Policies to reduce surgical rates in the English NHS cannot be justified on the grounds of avoiding inappropriate operations or increasing cost-utility, as higher surgical rates are not meaningfully associated with lower patient need or less benefit.
Higher surgical rates were associated with negligible pre-op need reduction; challenges volume-reduction policies but leaves appropriateness open.
To determine if higher rates of surgery are associated with lower levels of need (patients' pre-operative reports of their symptoms, functional status and quality of life) and with less benefit (patients' post-operative reports). Patient-reported outcome measures (PROMs) collected before and after joint replacement, hernia repair or varicose vein (VV) surgery in National Health Service (NHS)-funded patients (2009/11). Regression analysis for associations between 10% increase in rates and mean PROM score for Primary Care Trust (PCT) populations. National rate for hip and knee replacement increased by 6%, unchanged for hernia repair and decreased by 26% for VV surgery. Changes in PCT rates varied but had little or no association with the mean level of need of patients: 10% increase in the rate was associated with only 0.3% decline in the pre-operative PROM score for knee replacement (P < 0.05) and VV surgery (P < 0.001) and no significant change for other procedures. There was no significant association between a 10% change in the rate and the amount of benefit from surgery apart from a slight reduction (0.46%; P < 0.001) in the disease-specific PROM score for VV surgery. Policies by commissioners to reduce surgical rates in the English NHS cannot be justified on the grounds of avoiding inappropriate operations or increasing cost-utility.
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Black et al. (2013) conducted an observational in Joint replacement, hernia repair, or varicose vein. 10% increase in surgical rates was evaluated on Mean patient-reported outcome measure (PROM) score for pre-operative need and post-operative benefit (p=<0.001). A 10% increase in surgical rates was associated with only a 0.3% decline in pre-operative PROM scores for knee replacement (P<0.05) and varicose vein surgery (P<0.001).