http://www.bjj.boneandjoint.org.uk/content/96-B/1/70.abstract

Temporal trends and geographical variation in the use of subacromial decompression and rotator cuff repair of the shoulder in England

1. A. Judge, PhD, MSc, BSc, Senior statistician and departmental lecturer in musculoskeletal epidemiology1 ; 
2. R. J. Murphy, MA, MBChB, MRCS, Lord Nuffield Scholar in Orthopaedic Surgery1; 
3. R. Maxwell, MSc, Senior Analyst2; 
4. N. K. Arden, FRCP, CSST, MD, Professor of Rheumatology1; and 
5. A. J. Carr, FMedSci, MA, ChM, Nuffield Professor of Orthopaedics, Head of the Department1 

+Author Affiliations

1. 1University of Oxford, Oxford NIHR Musculoskeletal Biomedical Research Unit, Windmill Road, Headington, Oxford, OX3 7LD, UK.
2. 2Public Health England, Knowledge and Intelligence Team (South West), Grosvenor House, 149 Whiteladies Road, Bristol BS8 2RA, UK.

1. Correspondence should be sent to Dr A. Judge; e-mail:andrew.judge@ndorms.ox.ac.uk

Abstract

We explored the trends over time and the geographical variation in the use of subacromial decompression and rotator cuff repair in 152 local health areas (Primary Care Trusts) across England. The diagnostic and procedure codes of patients undergoing certain elective shoulder operations between 2000/2001 and 2009/2010 were extracted from the Hospital Episode Statistics database. They were grouped as 1) subacromial decompression only, 2) subacromial decompression with rotator cuff repair, and 3) rotator cuff repair only.

The number of patients undergoing subacromial decompression alone rose by 746.4% from 2523 in 2000/2001 (5.2/100 000 (95% confidence interval (CI) 5.0 to 5.4) to 21 355 in 2009/2010 (40.2/100 000 (95% CI 39.7 to 40.8)). Operations for rotator cuff repair alone peaked in 2008/2009 (4.7/100 000 (95% CI 4.5 to 4.8)) and declined considerably in 2009/2010 (2.6/100 000 (95% CI 2.5 to 2.7)).

Given the lack of evidence for the effectiveness of these operations and the significant increase in the number of procedures being performed in England and elsewhere, there is an urgent need for well-designed clinical trials to determine evidence of clinical effectiveness.

Cite this article: Bone Joint J 2014;96-B:70–4.

Footnotes

• The HES data were made available by the NHS Health and Social Care Information Centre. Copyright © 2012, Re-used with the permission of The Health and Social Care Information Centre. All rights reserved. HES data for this analysis were extracted using the HES online service by Public Health England who did not receive funding for this work. This work is based on data provided through EDINA UK Borders with support from the ESRC and JISC, and used material that is copyright of the Crown. We would like to thank Ms S. Sheard for her help in preparing the manuscript. This work was supported by the Oxford NIHR Musculoskeletal Biomedical Research Unit, Nuffield Orthopaedic Centre, University of Oxford. The opinions expressed by the authors are theirs alone and do not represent the opinions of supporting organisations.The UKUFF trial was funded by the NIHR Health Technology Assessment programme (project number 05/47/02). See the HTA programme website for further project information. The views and opinions expressed are those of the authors and do not necessarily reflect those of the NIHR HTA programme or the Department of Health.
  No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article.
  This article was primary edited by D. Rowley and first-proof edited by J. Scott.

• Received June 3, 2013.
• Accepted September 4, 2013.

• ©2014 The British Editorial Society of Bone & Joint Surgery