Prioritization versus rationing of healthcare – elective surgery is not optional surgery

Clement, Nick D; Skinner, John; Haddad, Fares S.; Simpson, A. H. R. W.

doi:10.1302/2046-3758.115.bjr-2022-0130

Cited by 8 publications

(12 citation statements)

References 17 publications

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“…As priority level four currently suggests that a patient waiting longer than three months will not come to harm. 7 , 26 The ideal resolution may be that all patients receive their surgery within three months of being placed on the waiting list, but this is not likely to be the case for several years. 27 , 28 An additional option is to try and avoid deterioration in, and maybe improve, HRQoL by offering patients waiting for surgery a prehabilitation package of care, which has been shown to improve HRQoL.…”

Section: Discussionmentioning

confidence: 99%

“…It is recognized that there is a deterioration in HRQoL and joint-specific function with increasing waiting time to THA and KA, and if this is associated with an increased postoperative mortality risk this would have repercussions on waiting time targets and prioritization for patients. 7 The primary aim of this study was to assess whether preoperative HRQoL was associated with postoperative mortality following THA and KA. Secondary aims were to assess: 1) patient demographics/comorbidities; or 2) whether joint-specific function were associated with postoperative mortality.…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Preoperative health-related quality of life is independently associated with postoperative mortality risk following total hip or knee arthroplasty

et al. 2022

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Aims The primary aim was to assess whether preoperative health-related quality of life (HRQoL) was associated with postoperative mortality following total hip arthroplasty (THA) and knee arthroplasty (KA). Secondary aims were to assess whether patient demographics/comorbidities and/or joint-specific function were associated with postoperative mortality. Methods Patients undergoing THA (n = 717) and KA (n = 742) during a one-year period were identified retrospectively from an arthroplasty register. Patient demographics, comorbidities, Oxford score, and EuroQol five-dimension (EQ-5D) were recorded preoperatively. Patients were followed up for a minimum of seven years and their mortality status was obtained. Cox regression analysis was used to adjust for confounding. Results During the study period, 111 patients (15.5%) undergoing THA and 135 patients (18.2%) undergoing KA had died at a mean follow-up of 7.5 years (7 to 8). When adjusting for confounding, the preoperative EQ-5D was associated with postoperative mortality, and for each 0.1 difference in the utility there was an associated change in mortality risk of 6.7% (p = 0.048) after THA, and 6.8% (p = 0.047) after KA. Comorbidities of connective tissue disease (p ≤ 0.026) and diabetes (p ≤ 0.028) were associated with mortality after THA, whereas MI (p ≤ 0.041), diabetes (p ≤ 0.009), and pain in other joints (p ≤ 0.050) were associated with mortality following KA. The preoperative Oxford score was associated with mortality, and for each one-point change in the score there was an associated change in mortality risk of 2.7% (p = 0.025) after THA and 4.3% (p = 0.003) after KA. Conclusion Worse preoperative HRQoL and joint specific function were associated with an increased risk of postoperative mortality. Both HRQoL and joint-specific function decline with longer waiting times to surgery for THA and KA and therefore may result in an increased postoperative mortality risk than would have been expected if surgery had been undertaken earlier. Cite this article: Bone Jt Open 2022;3(12):933–940.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Preoperative health-related quality of life is independently associated with postoperative mortality risk following total hip or knee arthroplasty

et al. 2022

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“…COVID-19 has had a devastating effect on healthcare services and has contributed to millions of patients waiting for planned hospital treatment, In England alone more than six and a half million are waiting, of whom more than 750,000 are orthopaedic patients. 1,2 It is estimated that those awaiting surgery may double; 3 in October 2021, there were more than 300,000 patients waiting longer than one year for treatment. 4 This had increased from only 1,032 patients in July 2019.…”

Section: Introductionmentioning

confidence: 99%

“…In England alone more than six and a half millionarewaiting,ofwhommorethan750,000 are orthopaedic patients. 1,2 It is estimated that thoseawaitingsurgerymaydouble; 3 2021,thereweremorethan300,000patientswaitinglonger than one year for treatment. 4 This had increased from only 1,032 patients in July 2019.…”

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confidence: 99%

Significant deterioration in quality of life and increased frailty in patients waiting more than six months for total hip or knee arthroplasty

Clement

Wickramasinghe

Bayram

et al. 2022

The Bone & Joint Journal

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Aims The primary aim of this study was to assess whether patients waiting six months or more for a total hip (THA) or knee (KA) arthroplasty had a deterioration in their health-related quality of life (HRQoL). Secondary aims were to assess changes in frailty and the number of patients living in a state considered to be worse than death (WTD), and factors associated with changes in HRQoL and frailty. Methods This cross-sectional study included 326 patients, 150 males (46.0%) and 176 females (54.0%), with a mean age of 68.6 years (SD 9.8) who were randomly selected from waiting lists at four centres and had been waiting for six months or more (median 13 months, interquartile range 10 to 21) for a primary THA (n = 161) or KA (n = 165). The EuroQol five-dimension questionnaire (EQ-5D) and visual analogue scores (EQ-VAS), Rockwood Clinical Frailty Scale (CFS), and 36-Item Short Form Survey subjective change in HRQoL were assessed at the time and recalled for six months earlier. A state that was WTD was defined as an EQ-5D of less than zero. Results There were significant deteriorations in the EQ-5D (mean 0.175, 95% confidence interval (CI) 0.145 to 0.204; p < 0.001), EQ-VAS (mean 8.6, 95% CI 7.0 to 10.4; < 0.001), and CFS (from 3 “managing well” to 4 “vulnerable”; p < 0.001), and a significant increase in the number of those in a state that was WTD (n = 48; p < 0.001) during the previous six months for the whole cohort. A total of 110 patients (33.7%) stated that their health was much worse and 107 (32.8%) felt it was somewhat worse compared with six months previously. A significantly greater EQ-5D (-0.14, 95% CI 0.08 to 0.28; p = 0.038) and a state that was not WTD (-0.14, 95% CI 0.01 to 0.26; p = 0.031) were associated with a deterioration in the EQ-5D. THA (0.21, 95% CI 0.07 to 0.34; p = 0.002) or a lower (better) CFS (0.14, 95% CI 0.07 to 0.20; p < 0.001) were independently significantly associated with a deterioration in the CFS. Conclusion Patients waiting more than six months for THA or KA had a significant deterioration in their HRQoL and increased frailty, with two-thirds of patients feeling that their health had worsened. Cite this article: Bone Joint J 2022;104-B(11):1215–1224.

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A preoperative package of care for osteoarthritis, consisting of weight loss, orthotics, rehabilitation, and topical and oral analgesia (OPPORTUNITY): a two-centre, open-label, randomised controlled feasibility trial

Simpson,

Clement,

Simpson

et al. 2024

The Lancet Rheumatology

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Prioritization versus rationing of healthcare – elective surgery is not optional surgery

Cited by 8 publications

References 17 publications

Preoperative health-related quality of life is independently associated with postoperative mortality risk following total hip or knee arthroplasty

Preoperative health-related quality of life is independently associated with postoperative mortality risk following total hip or knee arthroplasty

Significant deterioration in quality of life and increased frailty in patients waiting more than six months for total hip or knee arthroplasty

A preoperative package of care for osteoarthritis, consisting of weight loss, orthotics, rehabilitation, and topical and oral analgesia (OPPORTUNITY): a two-centre, open-label, randomised controlled feasibility trial

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