Trends over time and geographical variation in admission rates for plastic surgery in England.

The epidemiology of provision of plastic surgical care is poorly understood. Anecdotally, plastic surgeons in England have reported an increasing volume of work. However, it is unclear how much the workload has increased, and whether there is much geographical variation in workload within a publicly funded healthcare system. Data from English national hospital statistics from 1968-2004 and the Oxford Record Linkage Study (ORLS) from 1963-2004 were analysed for plastic surgery to study long-term trends. Linkage enables analyses to be undertaken in which individuals are counted once only each year regardless of how many plastic surgical admissions they had in the year. In addition, linked hospital admission data for plastic surgery in England, available from 2001-2005, were analysed to study geographical variation. Admission rates increased very substantially over the last four decades: per 100,000 population, they were 71 per 100,000 in England in 1968 and 408 by 2004. Admission rates in the ORLS area, measured as episodes per 100,000, rose from 73 in 1963 to 452 in 2004; and the corresponding figures for person-based rates rose from 63 to 400. Thus the increase in admission rates was a genuine, substantial increase in numbers of people in receipt of Plastic surgical care and not simply an increase in multiple admissions per patient. Geographical analysis showed 4.6-fold variation in admission rates for residents of the health authority areas (range 154 (Hampshire and the Isle of Wight) to 716 (County Durham and Tees Valley) admissions per 100,000 population). We discuss implications of the findings for workforce planning and service design in Plastic surgery within the context of the NHS, and how they may be applied to plastic surgical healthcare models globally. Detailed analysis of case-mix in the speciality, aimed at increasing understanding of both trends and geographical variation, is warranted