Ineffective surgical procedures are used to treat Canadians with osteoarthritis

BMJ 2010; 341 doi: (Published 29 December 2010) Cite this as: BMJ 2010;341:c7436
  1. Barbara Kermode-Scott
  1. 1Ottawa

Thousands of unnecessary therapeutic knee arthroscopies and vertebroplasties continue to be carried out in Canada despite evidence that the procedures are essentially ineffective, reports the Canadian Institute for Health Information.

In December, the institute reported in Health Care in Canada 2010, that in 2008-9 more than 3600 therapeutic knee arthroscopies were performed in Canadian hospitals, despite mounting evidence from randomised controlled trials that the procedure is of little benefit.

The authors explained that studies suggest that arthroscopies fail to improve patient outcomes or reduce discomfort when used to treat osteoarthritis. Also, a substantial number of patients go on to receive a knee replacement within one year of their arthroscopic surgery. Although the trend in the number of knee arthroscopies is on the decline in Canada, there are still considerable variations in the rates of these surgical procedures across the country. By province, age standardised rates ranged from a low of 2.8 per 100 000 in Quebec to a high of 36.7 per 100 000 in Prince Edward Island.

The institute also reported that about 1050 vertebroplasty procedures were performed across Canada in 2008-9, up from about 600 in 2006-7. A substantial number of these procedures were for patients with osteoporotic vertebral fractures. The authors point out, however, that studies indicate that these patients are no better off than those who undergo placebo procedures.

Also, in 2008-9 there continued to be regional variations in the rates of caesarean section and hysterectomy across Canada. Although no agreed benchmarks exist for the appropriate use of these procedures, variations in surgical rates among Canadian jurisdictions suggest that some of these procedures may not be appropriate or necessary, suggests the institute. In 2008-9, the variation in primary caesarean section rates was almost twofold across the provinces and was threefold across Canada’s territories. Rates ranged from a high of 23% of deliveries in Newfoundland and Labrador to a low of 14% in the province of Manitoba, and a low of 5% in the territory of Nunavut.

In the same year, age standardised hysterectomy rates varied almost threefold across Canada’s provinces and territories. Rates ranged from a high of 512 per 100 000 women (age 20 years or older) in Prince Edward Island to a low of 311 per 100 000 in the province of British Columbia and a low of 185 per 100 000 in the territory of Nunavut. Age standardised hysterectomy rates were substantially higher (46%) for women living in rural areas (464 per 100 000).

Jeremy Veillard, the institute’s vice president of research and analysis, said, “Many of these procedures are medically necessary. However, the wide variation in surgical rates from region to region cannot simply be explained by differences in women’s health. When we see these kinds of variations, it is a cue to start asking questions about whether the care being provided is appropriate. Reducing unnecessary surgical procedures is beneficial to the patient, but there are cost implications for the system as well.”


Cite this as: BMJ 2010;341:c7436


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