title: Influence of surgical rate on patients' reported clinical need and outcomes in English NHS.
abstract: BACKGROUND
  To determine if higher rates of surgery are associated with lower levels of need (patients' pre-operative reports of their symptoms, functional status and quality of life) and with less benefit (patients' post-operative reports).
  
  
  METHODS
  Patient-reported outcome measures (PROMs) collected before and after joint replacement, hernia repair or varicose vein (VV) surgery in National Health Service (NHS)-funded patients (2009/11). Regression analysis for associations between 10% increase in rates and mean PROM score for Primary Care Trust (PCT) populations.
  
  
  RESULTS
  National rate for hip and knee replacement increased by 6%, unchanged for hernia repair and decreased by 26% for VV surgery. Changes in PCT rates varied but had little or no association with the mean level of need of patients: 10% increase in the rate was associated with only 0.3% decline in the pre-operative PROM score for knee replacement (P < 0.05) and VV surgery (P < 0.001) and no significant change for other procedures. There was no significant association between a 10% change in the rate and the amount of benefit from surgery apart from a slight reduction (0.46%; P < 0.001) in the disease-specific PROM score for VV surgery.
  
  
  CONCLUSIONS
  Policies by commissioners to reduce surgical rates in the English NHS cannot be justified on the grounds of avoiding inappropriate operations or increasing cost-utility.
authors.affiliation: Department of Health Services Research & Policy, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK.
authors.forename: N
authors.initials: N
authors.lastname: Black
authors.affiliation: Department of Health Services Research & Policy, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK.
authors.forename: M
authors.initials: M
authors.lastname: Varagunam
authors.affiliation: Department of Health Services Research & Policy, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK.
authors.forename: A
authors.initials: A
authors.lastname: Hutchings
mesh_terms: D019644:Arthroplasty, Replacement, Hip / Q000706:statistics & numerical data; D019645:Arthroplasty, Replacement, Knee / Q000706:statistics & numerical data; D005260:Female; D006301:Health Services Needs and Demand / Q000706:statistics & numerical data*; D006304:Health Status; D006552:Hernia, Inguinal / Q000601:surgery; D006801:Humans; D008297:Male; D010043:Outcome and Process Assessment, Health Care; D011788:Quality of Life; D013222:State Medicine / Q000706:statistics & numerical data*; D013514:Surgical Procedures, Operative / Q000706:statistics & numerical data*; D006113:United Kingdom / Q000453:epidemiology; D014648:Varicose Veins / Q000601:surgery
keywords: health services; management and policy; secondary and tertiary services