Table 1.
Counts and rates of low-value care for 27 procedures, and average annual percentage change in low-value episodes for 14 procedures with higher volumes of low-value care
| Procedure | Number of episodes | Number (%) of low-value episodes* | Average annual percentage change in low-value care, 2010–2011 to 2016–2017† | ||
| Narrower | Broader | Narrower | Broader | ||
| Endoscopy in adults <55 | 14 813 | 2018 (13.62) | 2360 (15.93) | 7 (6–8) | 9 (8–9) |
| Knee arthroscopy | 4218 | 1106 (26.22) | 3002 (71.17) | −8 (−9 to −7) | −4 (−5 to −3) |
| Hysterectomy | 3861 | 736 (19.06) | 1207 (31.26) | −4 (−5 to −3) | −4 (−5 to −3) |
| Colonoscopy in adults <50 | 11 790 | 523 (4.44) | 608 (5.16) | 4 (2–5) | 5 (4–7) |
| Endovascular repair of abdominal aortic aneurysm | 405 | 175 (43.2) | 236 (58.3) | −2 (−5 to 0) | −2 (−4 to 1) |
| Percutaneous coronary intervention | 7783 | 130 (1.67) | 341 (4.38) | 0 (−4 to 3) | 3 (1–6) |
| Carotid endarterectomy | 408 | 80 (19.6) | 93 (22.8) | −5 (−9 to −2) | −6 (−9 to −2) |
| Renal artery angioplasty | 85 | 76 (89) | 76 (89) | −8 (−12 to −5) | −8 (−12 to −5) |
| Vena cava filters | 191 | 70 (36.7) | 191 (100) | −1 (−5 to 3) | 0 (−3 to 3) |
| Surgery for vesicoureteric reflux | 115 | 44 (38) | 44 (38) | 2 (−4 to 8) | 2 (−4 to 8) |
| Sentinel lymph node biopsy | 2485 | 39 (1.57) | 236 (9.50) | 16 (9–23) | 13 (9–15) |
| ERCP | 420 | 35 (8.3) | 79 (18.8) | −13 (−19 to −8) | −12 (−16 to −9) |
| Spinal fusion | 1042 | 26 (2.50) | 321 (30.81) | 4 (−4 to 11) | 6 (4–9) |
| Epidural steroid injection | 184 | 23 (12.5) | 30 (16.3) | −14 (−20 to −8) | −12 (−18 to −6) |
| Vertebroplasty | 45 | 15 (33) | 45 (100) | ||
| Bariatric surgery | 307 | 15 (4.9) | 15 (4.9) | ||
| Nasolacrimal probe in infants | 9 | 9 (100) | 9 (100) | ||
| Vertebral biopsy | 40 | 4 (10) | 40 (100) | ||
| Retinal laser or cryotherapy | 1409 | 4 (0.28) | 17 (1.21) | ||
| Hyperbaric oxygen | 31 | 4 (13) | 10 (33) | ||
| Laparoscopic uterine nerve ablation | 10 | 3 (30) | 10 (100) | ||
| Gall bladder removal during bariatric surgery | 5 | 1 (20) | 1 (20) | ||
| Electrotherapy | 62 | 0 (0) | 62 (100) | ||
| Pelvic lymphadenectomy | 42 | 0 (0) | 21 (50) | ||
| Endometrial biopsy | 18 | 0 (0) | 0 (0) | ||
| Radiotherapy after radical prostatectomy | 1289 | 0 (0) | 0 (0) | ||
| Electroconvulsive therapy in children | 0 | 0 | 0 | ||
*For definitions of low-value care, see online supplementary table 1.
†Average annual percentage changes were only estimated for the 14 procedures with the highest numbers of low-value episodes (narrower definition).
ERCP, endoscopic retrograde cholangiopancreatography.