Linear regression analysis of Hospital Episode Statistics predicts a large increase in demand for elective hand surgery in England

Abstract

Introduction: We integrated two factors, demographic population shifts and changes in prevalence of disease, to predict future trends in demand for hand surgery in England, to facilitate workforce planning.

Methods: We analysed Hospital Episode Statistics data for Dupuytren's disease, carpal tunnel syndrome, cubital tunnel syndrome, and trigger finger from 1998 to 2011. Using linear regression, we estimated trends in both diagnosis and surgery until 2030. We integrated this regression with age specific population data from the Office for National Statistics in order to estimate how this will contribute to a change in workload over time.

Results: There has been a significant increase in both absolute numbers of diagnoses and surgery for all four conditions. Combined with future population data, we calculate that the total operative burden for these four conditions will increase from 87,582 in 2011 to 170,166 (95% confidence interval 144,517-195,353) in 2030.

Discussion: The prevalence of these diseases in the ageing population, and increasing prevalence of predisposing factors such as obesity and diabetes, may account for the predicted increase in workload. The most cost effective treatments must be sought, which requires high quality clinical trials. Our methodology can be applied to other sub-specialties to help anticipate the need for future service provision.

Keywords: Carpal tunnel; Cubital tunnel; Dupuytren's disease; Incidence; Trigger finger; Workforce planning.

Figure 1

Population of England 1998–2030. Data is stratified by age groups. Source of data – the Office for National Statistics.

Figure 2

Absolute numbers of diagnoses of Dupuytren's Disease, 1998–2011. Solid lines represent the means, and dotted lines the 95% confidence intervals of linear regression analysis performed on the data. For all age groups combined r² = 0.96.

Figure 3

Absolute numbers of operations for Dupuytren's Disease, 2000–2011. Solid lines represent the means, and dotted lines the 95% confidence intervals of linear regression analysis performed on the data. For all age groups combined r² = 0.96.

Figure 4

Predicted future operation rates for Dupuytren's disease. Filled symbols represent the mean and error bars the 95% confidence intervals of the estimates.

Figure 5

Ratio of number of operations per diagnosis for four common hand conditions, 2000 – 2011.

Figure 6

Absolute numbers of diagnoses for four common hand conditions, 2000–2011. Solid lines represent the means, and dotted lines the 95% confidence intervals of linear regression analysis performed on the data. For carpal tunnel r² = 0.90; Dupuytren's disease r² = 0.96; trigger finger r² = 0.93; cubital tunnel r² = 0.94.

Figure 7

Absolute numbers of operations for four common hand conditions, 2000–2011. Solid lines represent the means, and dotted lines the 95% confidence intervals of linear regression analysis performed on the data. For carpal tunnel r² = 0.83; Dupuytren's disease r² = 0.96; trigger finger r² = 0.93; cubital tunnel r² = 0.95.

Figure 8

Predicted future operation rates for four common hand conditions. Error bars represent 95% confidence intervals.