Waiting lists for symptomatic joint arthritis are not benign

Abstract

Aim Restarting elective services presents a challenge to restore and improve many of the planned patient care pathways which have been suspended during the response to the COVID-19 pandemic. A significant backlog of planned elective work has built up representing a considerable volume of patient need. We aimed to investigate the health status, quality of life, and the impact of delay for patients whose referrals and treatment for symptomatic joint arthritis had been delayed as a result of the response to COVID-19. Methods We interviewed 111 patients referred to our elective outpatient service and whose first appointments had been cancelled as a result of the response to the COVID-19 pandemic. Results Patients reported significant impacts on their health status and quality of life. Overall, 79 (71.2%) patients reported a further deterioration in their condition while waiting, with seven (6.3%) evaluating their health status as ‘worse than death’. Conclusions Waiting lists are clearly not benign and how to prioritize patients, their level of need, and access to assessment and treatment must be more sophisticated than simply relying on the length of time a patient has been waiting. This paper supports the contention that patients awaiting elective joint arthroplasty report significant impacts on their quality of life and health status. This should be given appropriate weight when patients are prioritized for surgery as part of the recovery of services following the COVID-19 pandemic. Elective surgery should not be seen as optional surgery—patients do not see it in this way.

National operating volume for primary hip and knee arthroplasty in the COVID-19 era: a study utilizing the Scottish arthroplasty project dataset

“…End-stage symptomatic arthritis is not a benign condition. 13 Patients can suffer mentally, physically, and may struggle to return to work. 14 Under normal circumstances, 12% to 19% of patients awaiting THA and TKA, are defined as living in a health state “worse than death” according to the EuroQol five-level dimension (EQ-5D).…”

How to prioritize patients and redesign care to safely resume planned surgery during the COVID-19 pandemic

“… 28 The authors suggested that all non-critical surgery should be postponed. However, to the patient, delay of planned surgery may result in significant harm to physical and mental health, 2 , 3 irreversible disability, loss of income, and in some conditions such as cancer, reduced life expectancy. 29 , 30 To society, delay is likely to result in missed education, unemployment, and an increased demand on the healthcare system and welfare state.…”

“… 2 On the other hand, some patients may prefer to defer planned surgery due to fear of contracting the disease during hospitalization, which may result in loss of function and reduced life expectancy as a result of delay. Waiting is far from benign—patients are in physical and psychological distress, 3 - 5 and may get worse 6 and consequently benefit less from surgery. 7 Furthermore, cancellation due to COVID-19 has compounded existing symptoms with significant anxiety, related to job insecurity and economic uncertainty.…”

The rate of patient deferral and barriers to going forward with elective orthopaedic surgery during the COVID-19 pandemic

“…Inpatient stay is associated with risk and there is an argument for focusing on day case work or healthy American Society of Anesthesiologists (ASA) grade 17 1 patient mix, 2 but this may be to the detriment of older, less healthy individuals and does not account for the socioeconomic impact of providing continued nonoperative care for long-term treatable surgical conditions, which can lead to worsening comorbidity. 18 , 19 …”