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Unnecessary care in orthopaedic surgery.

Alex B Boyle1, Ian A Harris2

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Unnecessary orthopaedic surgery, where harm outweighs benefit, is common, leading to patient harm and increased costs. Addressing this requires better evidence and aligned incentives for high-value care.

Keywords:
clinical variationevidence‐based medicineorthopaedic surgeryovertreatment

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Area of Science:

  • Medicine
  • Orthopaedic Surgery
  • Health Policy

Background:

  • Unnecessary medical care, defined as care where potential harm exceeds potential benefit, is prevalent.
  • Orthopaedic surgery is a significant area where this issue manifests, impacting patient safety and healthcare spending.
  • Geographic variations in orthopaedic surgical practices exist, often unexplained by patient population differences.

Purpose of the Study:

  • To review the issue of unnecessary care within orthopaedic surgery.
  • To identify contributing factors to unnecessary interventions in this specialty.
  • To discuss implications for patient safety and healthcare expenditure.

Main Methods:

  • This study employed a narrative review methodology.
  • It synthesized existing literature on unnecessary care in orthopaedic surgery.
  • The review considered evidence gaps, practice variations, and cognitive and systemic factors.

Main Results:

  • Many orthopaedic interventions lack robust, low-bias evidence supporting their use.
  • Factors contributing to unnecessary care include evidence gaps, the evidence-practice gap, cognitive biases, and health system influences.
  • The economic burden and patient morbidity associated with unnecessary orthopaedic procedures are likely substantial.

Conclusions:

  • Unnecessary care in orthopaedic surgery poses risks to patients and incurs significant costs.
  • Solutions involve raising awareness, aligning financial incentives towards high-value care, and advocating for rigorous evidence.
  • Addressing this problem is crucial for improving patient outcomes and healthcare sustainability.