Performing a knee arthroscopy among patients with degenerative knee disease: one-third is potentially low value care

T. Rietbergen, P.J. Marang-van de Mheen, R.L. Diercks, Rob P.A. Janssen, H.M.J. van der Linden-van der Zwaag, Rob G.H.H. Nelissen, E.W. Steyerberg, L. van Bodegom-Vos (Corresponding author)

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Abstract

Purpose
The purpose of this study was to assess in which proportion of patients with degenerative knee disease aged 50+ in whom a knee arthroscopy is performed, no valid surgical indication is reported in medical records, and to explore possible explanatory factors.

Methods
A retrospective study was conducted using administrative data from January to December 2016 in 13 orthopedic centers in the Netherlands. Medical records were selected from a random sample of 538 patients aged 50+ with degenerative knee disease in whom arthroscopy was performed, and reviewed on reported indications for the performed knee arthroscopy. Valid surgical indications were predefined based on clinical national guidelines and expert opinion (e.g., truly locked knee). A knee arthroscopy without a reported valid indication was considered potentially low value care. Multivariate logistic regression analysis was performed to assess whether age, diagnosis (“Arthrosis” versus “Meniscal lesion”), and type of care trajectory (initial or follow-up) were associated with performing a potentially low value knee arthroscopy.

Results
Of 26,991 patients with degenerative knee disease, 2556 (9.5%) underwent an arthroscopy in one of the participating orthopedic centers. Of 538 patients in whom an arthroscopy was performed, 65.1% had a valid indication reported in the medical record and 34.9% without a reported valid indication. From the patients without a valid indication, a joint patient–provider decision or patient request was reported as the main reason. Neither age [OR 1.013 (95% CI 0.984–1.043)], diagnosis [OR 0.998 (95% CI 0.886–1.124)] or type of care trajectory [OR 0.989 (95% CI 0.948–1.032)] were significantly associated with performing a potentially low value knee arthroscopy.

Conclusions
In a random sample of knee arthroscopies performed in 13 orthopedic centers in 2016, 65% had valid indications reported in the medical records but 35% were performed without a reported valid indication and, therefore, potentially low value care. Patient and/or surgeons preference may play a large role in the decision to perform an arthroscopy without a valid indication. Therefore, interventions should be developed to increase adherence to clinical guidelines by surgeons that target invalid indications for a knee arthroscopy to improve care.
Original languageEnglish
Pages (from-to)1568-1574
Number of pages7
JournalKnee Surgery, Sports Traumatology, Arthroscopy
Volume30
Issue number5
DOIs
Publication statusPublished - May 2022

Funding

SMART study group : P. Pander, MD, Department of Orthopaedic Surgery, Northwest clinics orthopaedic department, Alkmaar, the Netherlands; D. J. Hofstee, MD, Department of Orthopaedic Surgery, Northwest clinics orthopaedic department, Alkmaar, the Netherlands; R. C. I. van Geenen, MD, PhD, Department of Orthopaedic Surgery, Amphia Hospital, Breda, the Netherlands; K. L. M. Koenraadt, Foundation for orthopedic research, care & education (FORCE), Amphia Hospital, Breda, the Netherlands; J. P. A. H. Onderwater, MD, Department of Orthopaedic Surgery, Antonius Zorggroep, Sneek/Emmeloord, the Netherlands; Y. V. Kleinlugtenbelt, MD, PhD, Department of Orthopaedic Surgery, Deventer Hospital, Deventer, the Netherlands; T. Gosens, MD, PhD, Department of Orthopaedic Surgery, Elisabeth-Tweesteden Hospital, Tilburg, the Netherlands; T. V. S. Klos, MD, PhD, Department of Orthopaedic Surgery, ICONE, Schijndel, the Netherlands; P. C. Rijk, MD, PhD, Department of Orthopaedic Surgery, Medical Center Leeuwarden, Leeuwarden, the Netherlands; B. Dijkstra, MSc, Department of Orthopaedic Surgery, Medical Center Leeuwarden, Leeuwarden, the Netherlands; A. V. C. M. Zeegers, MD, PhD, Department of Orthopaedic Surgery, Medisch Spectrum Twente, Enschede, the Netherlands; R. A. G. Hoogeslag, MD, Department of Orthopaedic Surgery, OCON, Hengelo, the Netherlands; M. H. A. Huis in’t Veld, PhD, Department of Orthopaedic Surgery, OCON, Hengelo, the Netherlands; A. A. Polak, MD, Department of Orthopaedic Surgery, Franciscus Gasthuis, Rotterdam, the Netherlands; N. R. Paulino Pereira, MD, PhD, Department of Orthopaedic Surgery, TerGooi Hospital, Hilversum, the Netherlands; T. M. J. S. Vervest, Department of Orthopaedic surgery, Tergooi Hospital, Hilversum, the Netherlands; H. C. van der Veen, MD, PhD, Department of Orthopaedics, University Medical Center Groningen, Groningen, the Netherlands. This study is funded by the Netherlands Organization for Health Research and Development (ZonMw) Grant 8392010022. They have no role in the study design or analysis.

FundersFunder number
Amphia Hospital
ZonMw : Dutch Organisation for Health Research and Development8392010022

    Keywords

    • Choosing Wisely
    • De-implementation
    • Degenerative knee disease
    • Knee arthroscopy

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