{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T23:56:28Z","timestamp":1777938988951,"version":"3.51.4"},"reference-count":27,"publisher":"SAGE Publications","issue":"4","license":[{"start":{"date-parts":[[2022,9,14]],"date-time":"2022-09-14T00:00:00Z","timestamp":1663113600000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Helse F\u00f8rde health trust","award":["38595\/2019"],"award-info":[{"award-number":["38595\/2019"]}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Scand J Surg"],"published-print":{"date-parts":[[2022,12]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Standardized surgery rates for common orthopedic procedures vary across geographical areas in Norway. We explored whether area-level factors related to demand and supply in publicly funded healthcare are associated with geographical variation in surgery rates for six common orthopedic procedures.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>The present study is a cross-sectional population-based study of hospital referral areas in Norway. We included adult admissions for arthroscopy for degenerative knee disease, arthroplasty for osteoarthritis of the knee and hip, surgical treatment for hip fracture, and decompression with\/without fusion for lumbar disk herniation and lumbar spinal stenosis in 2012\u20132016. Variation in age and sex standardized rates was estimated using extremal quotients, coefficients of variation, and systematic components of variation (SCV). Associations between surgery rates and the socioeconomic factors urbanity, unemployment, low-income, high level of education, mortality, and number of surgeons and hospitals were explored with linear regression analyses.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>Knee arthroscopy showed highest level of variation (SCV 10.3) and decreased in numbers. Variation was considerable for spine surgery (SCV 3.8\u20134.9), moderate to low for arthroplasty procedures (SCV 0.8\u20132.6), and small for hip fracture surgery (SCV 0.2). Higher rates of knee arthroscopy were associated with more orthopedic surgeons (adjusted coefficient 24.8, 95% confidence interval (CI): 2.7\u201347.0), and less urban population (adjusted coefficient \u221213.3, 95% CI: \u221225.4 to \u22121.2). Higher spine surgery rates were associated with more hospitals (adjusted coefficient 22.4, 95% CI: 4.6\u201340.2), more urban population (adjusted coefficient 2.1, 95% CI: 0.4\u20133.8), and lower mortality (adjusted coefficient \u2212192.6, 95% CI: \u2212384.2 to \u22121.1). Rates for arthroplasty and hip fracture surgery were not associated with supply\/demand factors included.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>Arthroscopy for degenerative knee disease decreased in line with guidelines, but showed high variation of surgery rates. Socioeconomic factors included in this study did not explain geographical variation in orthopedic surgery.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/14574969221118488","type":"journal-article","created":{"date-parts":[[2022,9,14]],"date-time":"2022-09-14T07:50:52Z","timestamp":1663141852000},"page":"92-98","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":3,"title":["Geographical variation in orthopedic procedures in Norway: Cross-sectional population-based study"],"prefix":"10.1177","volume":"111","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7347-3103","authenticated-orcid":false,"given":"Maria","family":"Holsen","sequence":"first","affiliation":[{"name":"Healthcare Atlas ServicesHelse F\u00f8rde Health Trust F\u00f8rde , Postboks 1000, Helse F\u00f8rde, F\u00f8rde 6807, Norway"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Veronica","family":"Hovind","sequence":"additional","affiliation":[{"name":"Helgeland Hospital, Mo i Rana, Norway Center for Clinical Documentation and Evaluation (SKDE), Troms\u00f8, Norway Department of Clinical Medicine, Faculty of Health Sciences, UiT the Arctic University of Norway, Troms\u00f8, Norway"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Haji K.","family":"Bedane","sequence":"additional","affiliation":[{"name":"Healthcare Atlas Services, Helse F\u00f8rde Health Trust, F\u00f8rde, Norway"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Knut I.","family":"Osvoll","sequence":"additional","affiliation":[{"name":"Healthcare Atlas Services, Helse F\u00f8rde Health Trust, F\u00f8rde, Norway"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jan-Erik","family":"Gjertsen","sequence":"additional","affiliation":[{"name":"The Norwegian Arthroplasty Register, Department of Orthopedic Surgery, Haukeland University Hospital, Bergen, Norway Department of Clinical Medicine, University of Bergen, Bergen, Norway"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ove N.","family":"Furnes","sequence":"additional","affiliation":[{"name":"The Norwegian Arthroplasty Register, Department of Orthopedic Surgery, Haukeland University Hospital, Bergen, Norway Department of Clinical Medicine, University of Bergen, Bergen, Norway"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mary E.","family":"Walsh","sequence":"additional","affiliation":[{"name":"School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tor","family":"Ingebrigtsen","sequence":"additional","affiliation":[{"name":"Department of Clinical Medicine, Faculty of Health Sciences, UiT the Arctic University of Norway, Troms\u00f8, Norway Department of Neurosurgery, Ophthalmology and Otorhinolaryngology, University Hospital of North Norway, Troms\u00f8, Norway Australian Institute of Health Innovation, Macquarie University, Sydney, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2022,9,14]]},"reference":[{"key":"bibr1-14574969221118488","unstructured":"Bale M, Aksnes JV, Holsen M, et al: Orthopaedic Healthcare Atlas for Norway. Use of orthopaedic health services 2012-2016. Helse F\u00f8rde health trust report 1\/2018."},{"key":"bibr2-14574969221118488","first-page":"17","volume":"140","author":"Ingebrigtsen T","year":"2020","journal-title":"Tidsskr Nor Legeforen"},{"key":"bibr3-14574969221118488","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2017-021199"},{"key":"bibr4-14574969221118488","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2018-028037"},{"key":"bibr5-14574969221118488","doi-asserted-by":"publisher","DOI":"10.1186\/s12891-019-2766-y"},{"key":"bibr6-14574969221118488","doi-asserted-by":"crossref","unstructured":"De Pina MDF, Ribeiro AI, Santos C. Epidemiology and variability of orthopaedic procedures worldwide. In: European Instructional Lectures, Springer, Berlin, Heidelberg, 2011, pp. 9\u201319.","DOI":"10.1007\/978-3-642-18321-8_2"},{"key":"bibr7-14574969221118488","unstructured":"FHI: Fylkesvise resultater om sykdomsbyrde, https:\/\/www.fhi.no\/div\/forskningssentre\/senter-sykdomsbyrde\/fylkesvise-resultater-om-sykdomsbyrde\/ (2021, accessed 28 June 2022)."},{"key":"bibr8-14574969221118488","unstructured":"Appleby J, Raleigh V, Frosini F, et al: Variations in Health Care: The Good, The Bad and The Inexplicable. King\u2019s Fund, London, 2011."},{"key":"bibr9-14574969221118488","doi-asserted-by":"publisher","DOI":"10.1126\/science.182.4117.1102"},{"key":"bibr10-14574969221118488","unstructured":"SKDE: Indikatorer for m\u00e5ling av uberettiget variasjon. Utre-dning fra SKDE for de regionale helseforetakene. 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Unders\u00f8kelse av \u00e5rsaker til variasjon i forbruk av helsetjenester. Del av Dokument 3:2 (2019\u20132020), https:\/\/www.riksrevisjonen.no\/globalassets\/rapporter\/no-2019-2020\/variasjonforbrukhelsetjenester.pdf(2019, accessed 1 July 2021)."}],"container-title":["Scandinavian Journal of Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/14574969221118488","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/14574969221118488","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/14574969221118488","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,2]],"date-time":"2026-05-02T04:59:02Z","timestamp":1777697942000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/14574969221118488"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,9,14]]},"references-count":27,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2022,12]]}},"alternative-id":["10.1177\/14574969221118488"],"URL":"https:\/\/doi.org\/10.1177\/14574969221118488","relation":{},"ISSN":["1457-4969","1799-7267"],"issn-type":[{"value":"1457-4969","type":"print"},{"value":"1799-7267","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,9,14]]}}}