The Belgian government limits the number of people over 50 that orthopedic surgeons are allowed to operate on the meniscus. Since mid-April, the number of patients aged 50 or older who undergo exploratory surgery in which the meniscus is (partially) removed may not exceed 45 percent per surgeon, according to a publication in the Belgian Official Gazette.
Until now, about 60 percent of these keyhole operations (meniscectomy) in Belgium have been performed on patients over the age of fifty. But in other (European) countries, this percentage is significantly lower, according to the National Institute for Health and Disability Insurance (RIZIV). Previous efforts to reduce the number of meniscus operations in the over-50s, which are considered ineffective according to RIZIV, hardly yielded anything.
Exceeding the maximum 45 percent of people over 50 who undergo surgery on the meniscus can be subject to a sanction, explains a spokesperson for RIZIV. ‘However, the 45 percent is a threshold value to alert doctors and to have them accountable. We are not just going to sanction,’ said the information officer. According to her, doctors retain their autonomy and continue to consider for themselves which care is appropriate for the patient. ‘So we are not taking over that role, but we do ask the doctor to take a number of things into account when making that assessment.
Risk of complications
According to NIHDI, meniscus operations in people over 50 often do not provide any benefit, but they do increase the risk of complications. It is the first time that the Belgian government has imposed such a restriction on doctors.