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Orthopaedic and trauma surgery in France: Do patterns differ across healthcare institution types (public community, public university, private not-for-profit, and private for-profit)? - 25/11/22

Doi : 10.1016/j.otsr.2022.103402 
Roger Erivan a, , Benoit Rigolot b, Guillaume Villatte a, Julien Dartus c, d, Stéphane Descamps a, Stéphane Boisgard a
a Université Clermont Auvergne, CHU Clermont-Ferrand, CNRS, SIGMA Clermont, ICCF, 63000 Clermont-Ferrand, France 
b Université Clermont Auvergne, CHU Clermont-Ferrand, 63000 Clermont-Ferrand, France 
c Université de Lille Nord de France, 59000 Lille, France 
d Service d’orthopédie, hôpital Roger Salengro, centre hospitalier et universitaire de Lille, place de Verdun, 59037 Lille, France 

*Corresponding author. Département de chirurgie orthopédique et traumatologique, hôpital Gabriel Montpied, CHU de Clermont-Ferrand, BP 69, 63003 Clermont-Ferrand, France.Département de chirurgie orthopédique et traumatologique, hôpital Gabriel Montpied, CHU de Clermont-FerrandBP 69Clermont-Ferrand63003France

Abstract

Background

No studies have evaluated, to our knowledge, potential differences in practices in France according to type of healthcare institution, i.e., university public hospital, community public hospital, or private hospital with or without participation in the public healthcare system. The objectives of this study of the exhaustive information collected in the French hospital-admission database were to: (1) describe the numbers of the main procedures performed in France by orthopaedic and trauma surgeons in each type of institution and each subspecialty; and (2) to determine whether the pattern of procedures differed according to the type of healthcare institution.

Hypothesis

Differences in surgical practice patterns exist across healthcare institution types and according to the nature of the procedures.

Patients and methods

A retrospective observational nationwide study was performed using the exhaustive French hospital database. All surgical procedures done in 2019 for orthopaedic and trauma indications were collected. We then classified the procedures according to the most common diagnoses by distinguishing procedures on the hip, knee, shoulder, hand, spine, ankle, and foot, as well as paediatric and traumatology procedures.

Results

Procedures performed more often in private institutions included those on the hip (93,225 [64.3%] of 144,919), knee (223,542 [75.5%] of 296,255), shoulder (103,923 [76.6%] of 300,577), hand (408,035 [77.6%] of 525,534), spine (for degenerative disease, 27,001 [71.2%] of 37,915), and ankle and foot (75,392 [77.1%] of 105,720). In contrast, of the 19,157 (80.3%) of the 23,848 paediatric procedures and 203,090 (67.7%) of the 300,065 traumatology procedures were done in public institutions. For all eight comparisons, the difference between public and private institutions was statistically significant. The overall trend was towards public university hospitals performing more paediatric and trauma procedures and more complex surgeries such as those required by multiple traumatic injuries.

Discussion

Our study provides accurate numbers of surgical procedures done in public and private healthcare institutions in France in 2019. We found major differences not only across categories and specialties but also within specialties depending on the type of procedure. Orthopaedic surgical activity shows a marked imbalance in France between public and private institutions. Further research would be needed to identify the causes.

Level of evidence

IV, retrospective observational epidemiological study.

Le texte complet de cet article est disponible en PDF.

Keywords : Epidemiology, Nationwide data, Private, Public, Orthopedic surgery


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Vol 108 - N° 8

Article 103402- décembre 2022 Retour au numéro
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