Geographical variation in orthopedic procedures in Norway: Cross-sectional population-based study

Area of Science:

• Orthopedic Surgery
• Healthcare Access
• Geographical Health Disparities

Background:

• Standardized surgery rates for common orthopedic procedures exhibit significant geographical variation across Norway.
• This study investigates the association between area-level healthcare demand and supply factors and these observed geographical variations.

Purpose of the Study:

• To explore the relationship between healthcare supply/demand factors and geographical variations in surgery rates for six common orthopedic procedures in Norway.
• To identify potential drivers of disparities in orthopedic surgery utilization.

Main Methods:

• A cross-sectional, population-based study analyzing adult admissions in Norwegian hospital referral areas from 2012-2016.
• Included procedures: knee arthroscopy, knee/hip arthroplasty, hip fracture surgery, lumbar decompression/fusion.
• Statistical analyses included variation estimation (SCV) and linear regression with socioeconomic and supply-side factors.

Main Results:

• Knee arthroscopy displayed the highest variation (SCV 10.3), with rates associated with more orthopedic surgeons and less urban populations.
• Spine surgery showed considerable variation (SCV 3.8-4.9), linked to more hospitals, urban populations, and lower mortality.
• Arthroplasty and hip fracture surgery rates were not significantly associated with the included supply/demand factors.

Conclusions:

• Despite a decrease in knee arthroscopy in line with guidelines, high geographical variation persists.
• The socioeconomic and supply-side factors examined in this study do not fully explain the geographical disparities in orthopedic surgery rates.