4 recommendations on measuring elective total joint, spine surgery appropriateness

Practice Management

A new study published in the Journal of Bone and Joint Surgery examines the appropriateness of elective orthopedic and spine procedures.

More than 80 percent of patients report pain relief and functional improvement with total knee and hip arthroplasty, and those procedures are among the most cost-effective in the United States with expenditures totaling around $10 billion annually. The study authors examined appropriateness with the RAND approach which addresses patient characteristics and evidence published in the literature.


The study authors examined retrospective appropriateness evaluations for total knee and hip replacements as well as lumbar laminectomy. They found 14 percent of the total joint cases and 49 percent of the spine procedures were deemed inappropriate; 27 percent of the total joints and 48 percent of the spine surgeries were deemed appropriate.


"The striking proportion of inappropriate determinations raises the question of whether surgeons are performing too much surgery, or whether the RAND approach to measuring appropriateness has important limitations that should be addressed in a new generation of appropriateness criteria," concluded the study authors.


The study authors recommended:


1. Clinicians use clinical guidelines as advisory tools but need a more specific metric to determine which treatment is appropriate.


2. Developing appropriateness ratings is currently too resource-intensive. As a result, many are still using the criteria developed in Spain in the 1990s to adjudicate appropriateness.


3. Use the current appropriateness data with caution, as it was developed several years ago and without patient perspectives.


4. The new generation of appropriateness criteria could overcome the current limitations.


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