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The impact of the 6-month waiting target for elective surgery: a patient record study
James Blackett1, Alex Carslaw, David Lees
1Department of Orthopaedics, Hastings Regional Hospital, Omahu Road, Private Bag 9014, Hastings 4120, New Zealand. jblackett@gmail.com.
Insights
A significant number of patients suitable for hip or knee replacement surgery in New Zealand were declined due to financial thresholds. Many experienced substantial pain and disability despite meeting surgical criteria.
Area of Science:
- Orthopaedic Surgery
- Health Economics
- Public Health Policy
Background:
- Access to elective surgery, such as total hip or knee arthroplasty, is crucial for patients with osteoarthritis.
- Financial thresholds can act as a barrier to accessing necessary surgical interventions, impacting patient outcomes.
Purpose of the Study:
- To quantify the proportion of patients declined for total hip or total knee arthroplasty due to financial thresholds.
- To analyze the New Zealand Orthopaedic Association (NZOA) prioritisation scores of patients who were declined surgery.
Main Methods:
- Retrospective review of patient records from two New Zealand District Health Boards (DHBs) between June 2012 and June 2013.
- Data collection included patient demographics, presenting condition (hip or knee osteoarthritis), NZOA prioritisation score, and surgical outcome (booked or declined).
Main Results:
- 36% of patients (307 out of 858) deemed suitable for hip or knee arthroplasty were declined due to financial thresholds.
- Patients declined for surgery had significantly lower mean NZOA scores compared to those who proceeded with surgery.
- Declined patients at Whangarei Base Hospital had a mean NZOA score of 55.39, while those booked had 70.62 (p<0.001). At Hawke's Bay Regional Hospital, declined patients scored 64.66 versus 76.96 for booked patients (p≤0.001).
Conclusions:
- A substantial proportion of patients eligible for hip and knee arthroplasty are denied surgery based on financial criteria.
- This financial barrier affects patients experiencing significant pain and disability, highlighting a critical issue in healthcare access.
Aim:
To quantify the number of patients declined surgery due to scoring below the financial threshold, when presenting for total hip or total knee arthroplasty at two New Zealand District Health Boards (DHBs).
Method:
Data from patients presenting with hip or knee osteoarthritis at both Whangarei Base Hospital and Hawke's Bay Regional Hospital from June 2012 to June 2013 were reviewed. Data were taken from hospital codes and patient records. The outcome from clinic visits were recorded as well as the patient's New Zealand Orthopaedic Association (NZOA) prioritisation score.
Results:
A total of 1202 patient records were reviewed: 393 from Whangarei Base Hospital and 809 from Hawke's Bay Regional Hospital. Of the 858 patients where surgery was both desired by the patient and deemed appropriate by the surgeon, 307 (36%) were declined for being below the financial threshold. These patients had a mean NZOA score of 66.42. At Whangarei Base Hospital, 300 patients were referred for surgery and 98 (33%) were declined for being below threshold. The mean NZOA score was significantly higher in the patients booked for surgery (M=70.62) compared with those declined below threshold (M=55.39, p<0.001). Of the 497 patients referred for arthroplasty at Hawke's Bay Regional Hospital, 205 (41%) were declined for being below threshold. The mean NZOA prioritisation scores were also significantly higher in the patients booked for surgery (M=76.96) compared to those declined (M=64.66; p less than or equal to 0.001).
Conclusion:
36% of patients who were suitable for hip or knee arthroplasty were declined elective surgery for being below threshold. Many of these patients have significant pain and disability.
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