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Table 7 Results of studies exploring surgical provision

From: Assessing demographic access to hip replacement surgery in the United Kingdom: a systematic review

Ref.

Study timeframe

Estimate of surgical provision

Socio-demographic domains

Conclusions

[31]

Financial year 1991/2 and financial year 2001/2

Admissions data from HES

- Age

- Gender

- Area-based deprivation (Townsend deprivation Z-score for 1991 and 2001 census data)

- 1991 hip replacement rate for adults over 44 years: 160 per 100.000, 2001 hip replacement rate: 184 per 100,000

Deprivation

- Decrease in inequality from 1991 to 2001 with increase in usage by most deprived patients (standard utilisation rate: 0.804 to 0.843) and decrease in usage for least deprived patients (1.135 to 1.075)

- To bring usage levels of most deprived quintile to the level of least deprived quintile, an increase of use of 41% was required in 1991, falling to 27% in 2001

- Utilisation ratio between most deprived and least deprived patients fell from 1.41 in 1991 (95% CI: 1.36–1.47) to 1.27 in 2001 (95% CI: 1.36–1.47)

[32]

Financial year 2002/3

Admissions data from HES

- Age

- Gender

- Area level deprivation (IMD 2004)

- Rurality of residence

- Ethnic mix of residence

- Hospital variables (number of hip operations, orthopaedic training centre status, rate of consultants, operating theatres and bed occupancy rates

Deprivation

- Weak evidence for a trend in relationship between SES and surgical provision

Age

- In patients aged 50-59, the more deprived patients received more provision, however effects weaken with increasing age – patients aged over 85 had opposite association

Gender

- Women had greater provision however association was weakest in the oldest and youngest age cohorts – strongest effect in urban areas

Ethnicity

- No association was found between provision and ethnicity

Rurality

- Non-urban dwelling patients had greater provision as did those living further away from hospitals

Hospital effects

- Higher volume of surgeries, more consultants, more anaesthetic consultants and more operating theatres were associated with greater provision

Geographical

- Certain variables such as gender varied geographically – in some areas men received greater provision, in other areas men receive worse provision

[4]

April 2003 to December 2012

Admissions data from HES

- Age

- Gender

- Area based deprivation (IMD 2010)

- Ethnicity

- Primary diagnosis

- BMI

- ASA score

- Quality of life (EQ-5D score)

- Provision of surgery for Black and Asian population lower than expected: Odds ratio for Black patients = 0.33 (95% CI: 0.31–0.35), Odds ratio for Asian patients = 0.20 (95% CI: 0.19–0.21)

Type of surgery

- Black patients were more likely to receive uncemented prostheses compared to cemented prostheses, in all age groups: Odds ratio = 1.43 (95% CI: 1.11–1.84)

Deprivation

- Ethnic minority patients were younger and lived in areas of greater deprivation than White patients

- Ethnic minority patient had better surgical fitness however (lower ASA grade)

Gender

- Ratio of expected versus observed surgeries was similar in men and women

Primary condition

- Osteoarthritis was most common primary condition for all ethnicities

- Black and Asian patients more likely to have osteonecrosis, inflammatory arthritis or congenital dysplasia as their primary condition, as well as ‘other reasons’

  1. NOTE: HES = Hospital Episode Statistics; CI = confidence intervals; IMD = Indices of Multiple Deprivation; SES = Socioeconomic status; NJR = National Joint Registry; BMI = Body mass index; ASA = American Society of Anaesthesiologists Physical Status Classification System; EQ-5D = EuroQol-5D