Influence of surgical rate on patients' reported clinical need and outcomes in English NHS.

Black, N; Varagunam, M; Hutchings, A; (2013) Influence of surgical rate on patients' reported clinical need and outcomes in English NHS. Journal of public health (Oxford, England), 36 (3). pp. 497-503. ISSN 1741-3842 DOI:

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BACKGROUND: 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).<br/> METHODS: 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.<br/> RESULTS: 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 &lt; 0.05) and VV surgery (P &lt; 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 &lt; 0.001) in the disease-specific PROM score for VV surgery.<br/> CONCLUSION: 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.<br/>

Item Type: Article
Faculty and Department: Faculty of Public Health and Policy > Dept of Health Services Research and Policy
PubMed ID: 23986543
Web of Science ID: 343698900020


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