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Published on: February 27, 2018
Does waiting for total hip replacement matter? Prospective cohort study
Shakoor Hajat1, Ray Fitzpatrick, Richard Morris
1Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK.
Insights
Waiting longer for total hip replacement surgery is linked to worse patient outcomes 12 months post-operation. This study highlights the impact of surgical wait times on recovery and pain levels.
Area of Science:
- Orthopaedic surgery
- Health services research
- Patient outcomes
Background:
- Total hip replacement (THR) is a common procedure for hip pain and disability.
- The impact of pre-operative waiting times on THR outcomes is not fully understood.
Purpose of the Study:
- To evaluate the association between the duration of waiting time for surgery and the outcome of total hip replacement.
Main Methods:
- Data from 143 hospitals in England were collected for THR surgeries between September 1996 and October 1997.
- Patient-reported pain and disability (Oxford Hip Score) were assessed pre-operatively and at 3 and 12 months post-operatively.
- Multiple regression analysis was used to analyze the relationship between waiting time and outcomes, adjusting for confounding variables.
Main Results:
- Most patients showed significant improvement in pain and disability 12 months after THR.
- Worse pre-operative Oxford Hip Scores were associated with longer outpatient and inpatient waiting times.
- Longer waiting times correlated with worse outcomes at 12 months, even after adjusting for confounding factors.
- Publicly funded patients and socially disadvantaged patients reported worse outcomes compared to privately funded and more advantaged patients, respectively.
Conclusions:
- Extended waiting times for total hip replacement surgery are associated with poorer patient outcomes at 12 months.
- Further research is needed to determine if this association persists in the longer term.
Objectives:
To assess the impact on the outcome of total hip replacement of the length of timing spent waiting for surgery.
Methods:
One hundred and forty-three orthopaedic and general hospitals provided information about aspects of surgical practice for each total hip replacement conducted between September 1996 and October 1997 for publicly and privately funded operations in five English health regions. These data were linked to patient information about hip-related pain and disability status (measured using the Oxford Hip Score) before operation and at 3 and 12 months after. Data were analysed using multiple regression analysis.
Results:
Questionnaires were completed by surgeons for 10,410 (78%) patients treated during the recruitment period and by 7151 (54%) patients. Twelve months after total hip replacement, the majority of patients experienced substantial improvements in hip-related pain and disability (as measured by the Oxford Hip Score). Those patients who started with a worse Oxford Hip Score before the operation tended to remain worse after the operation. Worse pre-operative score was associated with an increased length of either outpatient or inpatient wait, and this trend remained after the operation. The relationship between waiting time and outcome remained after adjustment for possible confounding variables. A consistently worse score was observed in public compared with private patients at all three time-points. In addition, in both sectors, those patients who were socially disadvantaged had a worse score than more socially advantaged patients both before and after the operation.
Conclusions:
Waiting for surgery is associated with worse outcomes 12 months later. Longer-term outcome needs to be considered to see if this association persists.
