Low-value musculoskeletal surgery remains common in parts of Finland

Background   Several widely used surgical treatments for musculoskeletal (MSK) conditions have turned out to offer limited health benefits. The prevalence and regional variation in the use of these low value surgeries as well as reasons for variation in Finland are not well understood.

Methods   This study investigated regional differences in the incidence of procedures in Finland for six common low value musculoskeletal surgeries. The register survey was sampled from the Health Care Notification Register (Hilmo) for the period 2006-2021.

Results   On average, 16 162 low-benefit musculoskeletal surgical procedures were performed in 2006-2007 in Finland, compared to 3 298 (-80%) in 2020-2021. The incidence of these treatments varied by up to 11-fold between public healthcare regions during 2020 and 2021. More procedures were performed in small population-sized regions, and in regions that started with high incidence. The incidence was relatively higher in private health care in areas where public health care performed fewer procedures. The incidence was higher in private health care in areas where public health care performed relatively fewer procedures.

Conclusions   The number of common low value musculoskeletal surgeries is steadily decreasing, but the regional variation is still quite large in both the public and private sectors indicating that the local treatment culture is the driving force behind the indications instead of high-quality evidence.