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Study shows 4 in 5 patients did not receive surgery 18 months after initial visit to orthopedic surgeon in Ontario


Four in five patients did not receive surgery following an orthopedic surgeon visit according to a new study by researchers at the Institute for Clinical Evaluative Sciences (ICES). While it is likely that all patients requiring surgery received it, further investigation is needed to determine if the high caseload of non-surgical cases affects wait times for appointments to see a surgeon, creating a barrier to access for timely surgical intervention for those in urgent need.

”Our study suggests that orthopedic surgeons are seeing a high volume of patients who do not need surgery, and that may be putting pressure on orthopedic resources, which may be impeding access to timely care,” says Elizabeth Badley, lead author of the study and an adjunct scientist at ICES.

The researchers found a substantial proportion of referrals were for expert diagnosis or advice on management and treatment. The findings also suggest socioeconomic inequalities in access to orthopedic care.

The population-based cohort study looked at all patients who had an initial ambulatory visit to an orthopedic surgeon between October 2004 and September 2005 in Ontario and found that:

  • Of the 477,945 patients in the cohort, 49 per cent visited orthopedic surgeons for injury and 24 per cent for arthritis.
  • Overall, 79.3 per cent of patients did not receive surgery within 18 months of their initial visit. 
  • The distribution by income quintile of patients visiting was skewed towards higher incomes.
  • Younger patients were significantly more likely to be non-surgical than those aged 65 years and older. 
  • The odds of not getting surgery were significantly higher for women than men for injury and other conditions; the opposite was true for arthritis and bone conditions. 

“An implication of our findings is that there may be a need to develop alternative strategies to provide ‘specialist’ input for non-surgical musculoskeletal care, particularly with the anticipated increasing demand for surgery as the population ages,” says Badley.

The study "Surgery or consultation: a population-based cohort study of use of orthopaedic surgeon services,” appears in the journal PLoS One

Authors: Badley EM, Canizares M, MacKay C, Mahomed NN, Davis AM.

ICES is an independent, non-profit organization that uses population-based health information to produce knowledge on a broad range of healthcare issues. Our unbiased evidence provides measures of health system performance, a clearer understanding of the shifting healthcare needs of Ontarians, and a stimulus for discussion of practical solutions to optimize scarce resources. ICES knowledge is highly regarded in Canada and abroad, and is widely used by government, hospitals, planners, and practitioners to make decisions about care delivery and to develop policy.

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