Table 4.
Community resource predictors of surgical rates
| Predictor | Procedure | Reference | Categories | Effect size | 95% Confidence interval | p | Comment |
|---|---|---|---|---|---|---|---|
| Surgeon supply | TJA/LSS | 53 | higher | N/R | Correlation | ||
| THA | 22 | OR, 1.52 | 0.01 | ||||
| THA | 30 | Quintiles | RR, 1.06 | (1.00–1.12) | 0.07 | ||
| THA | 44 | r, 0.06 | 0.7 | ||||
| TKA | 14 | r, −0.16 | 0.26 | ||||
| TKA | 30 | Quintiles | RR, 1.05 | (0.99–1.11) | 0.023 | ||
| TKA | 44 | r, 0.09 | 0.1 | ||||
| LSS | 7 | IRR, 0.98 | (0.96–1.01) | 0.2 | |||
| LSS | 54 | R-sq, 0.02 | |||||
| Surgeon Volume | LSS | 8 | High volume | OR, 2.9 | (2.5–3.2) | < 0.001 | Fusions to decompressions |
| Surgeon specialty | LSS | 8 | Orthopaedists | OR, 12.46 | (10.6–14.6) | < 0.001 | Fusions to decompressions |
| LSS | 54 | Orthopaedists | R-sq, 0.03 | ||||
| Surgeon attitudes | TKA | 61 | Enthusiasm | β, 6.7 | < 0.001 | Propensity of surgeons to operate | |
| TKA | 61 | Outcome perception | β, 0.14 | 0.08 | Perception of treatment outcomes | ||
| LSS | 7 | Enthusiasm | IRR, 1.26 | (1.05–1.51) | 0.013 | Propensity of surgeons to recommend surgery | |
| MD supply | THA | 22 | MD supply | OR, 0.68 | N/R | ||
| THA | 30 | Anes supply | RR, 0.9 | (0.86–0.95) | 0.001 | Highest to lowest quintile | |
| THA | 30 | MD supply | RR, 0.79 | (0.73–0.85) | 0.001 | Highest to lowest quintile | |
| THA | 37 | Anes supply | none | ||||
| TKA | 14 | PMR supply | r, −0.42 | 0.002 | |||
| TKA | 14 | Rheum supply | r, −0.25 | 0.08 | |||
| TKA | 14 | PCP supply | r, −0.10 | 0.47 | |||
| TKA | 30 | Anes supply | RR, 0.92 | (0.87–0.96) | 0.001 | Highest to lowest quintile | |
| TKA | 30 | MD supply | RR, 0.91 | (0.86–0.97) | 0.001 | Highest to lowest quintile | |
| LSS | 7 | PCP supply | IRR, 1.08 | (0.99–1.18) | 0.08 | ||
| MD factors | THA | 36 | PCP Trainers (%) | r, −0.24 | 0.05 | ||
| THA | 36 | Child Health GPs (%) | r, −0.36 | 0.003 | |||
| TKA | 61 | Female (%) | β, −6.5 | 0.02 | Linear regression parameter estimate | ||
| TKA | 61 | NA-trained (%) | β, −4.1 | 0.002 | Linear regression parameter estimate | ||
| LSS | 7 | Enthusiasm | IRR, 1.14 | (0.96–1.34) | 0.13 | Propensity of referring MDs to refer for surgery | |
| Hospital factors | THA | 17 | Hospital supply | r, −0.66 | 0.073 | Number of centers offering TJA | |
| THA | 22 | Hospital volume | OR, 2.54 | 0.01 | |||
| THA | 30 | Bed occupancy | RR, 0.98 | (0.93–1.03) | 0.12 | Highest to lowest quintile | |
| THA | 30 | Hosp Volume | RR, 1.11 | (1.05–1.18) | 0.005 | Highest to lowest quintile | |
| TKA | 17 | Hospital supply | r, −0.80 | 0.017 | Number of centers offering TJA | ||
| TKA | 30 | Bed occupancy | RR, 1.06 | (1.00–1.12) | 0.33 | Highest to lowest quintile | |
| TKA | 30 | Hosp Volume | RR, 1.09 | (1.03–1.16) | 0.001 | Highest to lowest quintile | |
| Hospital type | THA | 22 | Government Hosp | OR, 0.90 | N/R | ||
| THA | 22 | Insurance | OR, 2.46 | 0.01 | Private Insurance charges (%) | ||
| THA | 22 | Teaching | OR, 0.85 | N/R | |||
| THA | 30 | Teaching | RR, 0.97 | (0.93–1.01) | |||
| TKA | 30 | Teaching | RR, 0.9 | (0.86–0.95) | |||
| TKA | 61 | Teaching beds (%) | β, 1.2 | 0.04 | Linear regression parameter estimate | ||
| OR supply | THA | 30 | Day-case OR supply | RR, 0.93 | (0.88–0.99) | 0.12 | Highest to lowest quintile |
| THA | 30 | OR supply | RR, 1.11 | (1.03–1.20) | 0.005 | Highest to lowest quintile | |
| TKA | 30 | Day-case OR supply | RR, 1.11 | (1.04–1.18) | 0.011 | Highest to lowest quintile | |
| TKA | 30 | OR supply | RR, 0.96 | (0.91–1.01) | 0.018 | Highest to lowest quintile | |
| Medical costs | THA | 22 | MD Fees | OR, 0.10 | 0.05 | ||
| THA | 37 | Care expenses | increase | 0.001 | Need-adjusted expenses of specialized care | ||
| Imaging | LSS | 7 | MRI Scanners | IRR, 1.3 | (1.09–1.57) | 0.004 | |
| LSS | 35 | CT/MRI rates | R2, 0.22 | r, 0.47 | 0.001 |
TJA = total joint arthroplasty; LSS = lumbar spine surgery; HR = hazard ratio; OR = odds ratio; RR = rate ratio; r = correlation coefficient; β = regression parameter; IRR = incidence rate ratio; N/R = not reported; MDs = referring physicians, ORs = operating rooms; Anes = anesthesiologists; PMR = physical medicine and rehabilitation; Rheum = rheumatologists; PCP = primary care physicians; NA-trained = North-American-trained.