Declining incidence of acromioplasty in Finland

Abstract

Background and purpose: An increased incidence rate of acromioplasty has been reported; we analyzed data from the Finnish National Hospital Discharge Register.

Patients and methods: During the 14-year study period (1998-2011), 68,877 acromioplasties without rotator cuff repair were performed on subjects aged 18 years or older.

Results: The incidence of acromioplasty increased by 117% from 75 to 163 per 10(5) person years between 1998 and 2007. The highest incidence was observed in 2007, after which the incidence rate decreased by 20% to 131 per 10(5) person years in 2011. The incidence declined even more at non-profit public hospitals from 2007 to 2011. In contrast, it continued to rise at profit-based private orthopedic clinics.

Interpretation: We propose that this change in clinical practice is due to accumulating high-quality scientific evidence that shows no difference in outcome between acromioplasty and non-surgical interventions for rotator cuff disease with subacromial impingement syndrome. However, the exact cause of the declining incidence cannot be defined based solely on a registry study. Interestingly, this change was not observed at private clinics, where the number of operations increased steadily from 2007 to 2011.

Figure 1.

Incidence rates of acromioplasty in Finland, by year. Randomized controlled trials showing equal outcomes for operative and nonoperative treatment of stage-II impingement syndrome were reported by (a) Brox et al. (1999), (b) Haahr et al. (2005), (c) Ketola et al. (2005), (d) Haahr Andersen (2006), and (e) Ketola et al. (2009).

Figure 2.

Incidence rates of acromioplasty in Finland by year, according to patient age.

Figure 3.

Incidence rates of acromioplasty in Finland by year, in non-profit and profit healthcare organizations.