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Appropriate care in orthopedic patients: effectivity of a new guideline for diagnosis and treatment of Subacromial Pain Syndrome
ESSKA Academy. Veen B. May 9, 2018; 209940; P22-1310 Topic: Arthroscopic Surgery
Dr. Bart-Jan Veen
Dr. Bart-Jan Veen
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Abstract
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Objectives: In 2014 the guideline for diagnosis and treatment of subacromial pain syndrome (SAPS) was created by the Dutch Orthopedic Association in a cooperation with the specialist societies of Rehabilitation Medicine, Physiotherapy, Radiology and General Practitioners. In brief, it stated that SAPS can be treated by conservative therapy and surgery is not always needed. The guideline was published in Dutch and international journals and after that presented at several congresses and symposia.
The aim of this study is to evaluate the effect of the implementation of the guideline on the numbers of shoulder surgeries. Therefore we question: is the number of shoulder surgeries for SAPS reduced after introducing the guideline in 2014?

Methods: Information was collected from referred patients by their general practitioner (GP) to the orthopedic department. Data of the following national registration diagnosis codes were analyzed: 1450 (tendinitis supraspinatus/biceps, or impingement) and 1460 (rupture rotator cuff/ biceps tendon). This aggregated data was extracted from the national database of the Dutch Health Authority. Numbers are also noted of those patients who subsequently received surgery like bursectomy, arcromionectomy, and/or cuff repair. All data was complete for the years 2012, 2013 and 2014. For the years 2015 and 2016 this was complete for 90% and 65%, therefore this was extrapolated. From the Institute of Central Basis Statistics numbers of inhabitants for each year was retrieved to calculate incidence.

Results: In 2012 49.367 patients (incidence 0.29%) were referred by their GP of which 11.668 patients (23.6%) received shoulder surgery. In the year 2016, a converted total of 38.014 patients (incidence 0.28%) were referred and of which 6.741 patients (17.7%) received shoulder surgery. This is a significant decrease in shoulder surgeries (P<0.001). All numbers of different years and diagnosis codes will be shown. Also, they will be grouped by gender and age.

Conclusions: As a result of introducing the multidisciplinary guideline: 'diagnosis and treatment of subacromial pain syndrome' there is a decrease in shoulder surgeries for related diagnoses. This guideline will hopefully lead to appropriate health care and unnecessary surgeries can be avoided in the future.

Keywords:
shoulder, guidelines, subacromial pain syndrome, healthcare costs
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