The Impact of Waiting Time on Health Gains from Surgery: Evidence from a National Patient‐reported Outcome Dataset

Nikolova, Silviya; Harrison, Mark; Sutton, Matt

doi:10.1002/hec.3195

Cited by 52 publications

(44 citation statements)

References 26 publications

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“…To our knowledge, this is the first study to examine symptom duration in the context of THA outcomes. Our findings align with those in the study by Nikolova et al (18), which demonstrated that longer waiting times following the decision to operate were associated with poorer postsurgical outcomes for both THA and total knee arthroplasty. The findings of the present study are also similar to those demonstrated in the study by Fortin et al (8), who reported that poorer preoperative health resulted in poorer improvement from surgery.…”

Section: Discussionsupporting

confidence: 92%

“…The findings of the present study are also similar to those demonstrated in the study by Fortin et al (8), who reported that poorer preoperative health resulted in poorer improvement from surgery. However, Nikolova and colleagues (18) reported that an additional week of elective waiting time for surgery resulted in larger reduction of postsurgical OHS (-0.0951) and EQ-5D-3L scores (-0.0620) than our findings. This suggests that the waiting time once a patient is deemed ready for surgery may play a more important role than the duration of symptoms.…”

Section: Discussioncontrasting

confidence: 85%

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Association Between Symptom Duration and Patient‐Reported Outcomes Before and After Hip Replacement Surgery

Lau

Harrison

Sutton

2020

Arthritis Care & Research

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Objective Patients experience discomfort and compromised quality of life while waiting for hip replacement. Symptom duration may affect quality of life attained following surgery. We undertook this study to investigate the impact of symptom duration on patient‐reported postsurgical outcomes from hip replacement surgery. Methods National observational data collected before and after hip replacement surgery in England between 2009 and 2016 were used to investigate determinants of symptom duration prior to surgery and the relationship between symptom duration and presurgical and postsurgical patient‐reported outcomes. Multivariable linear regression models were used to estimate associations between patient‐reported outcomes and symptom duration, controlling for a range of covariates. Results The sample included 209,192 patients; most (69%) experienced symptoms for 1–5 years. A few patients (14%) experienced symptoms for <1 year, for longer than 5 years (6–10 years [11%]), or for >10 years (5%). Symptom duration decreased overall over the studied time period and was shorter among patients who were male, older, and from areas of lesser deprivation. Patients with a symptom duration <1 year had better postsurgical pain and function outcomes (Oxford Hip Score [OHS] 0.875 [95% confidence interval (95% CI) 0.777, 0.973]) than those with 1–5 years symptom duration in an adjusted model. Conversely, those with symptom duration >5 years had increasingly poorer postsurgical outcomes (OHS –0.730 [95% CI –0.847, –0.613] for those with disease duration 6–10 years and OHS –1.112 [95% CI –1.278, –0.946] for those with disease duration >10 years). Conclusion Symptom duration prior to hip replacement has become more standardized in England over time. However, increasing duration remains a significant predictor of poorer outcomes after surgery.

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Section: Discussionsupporting

confidence: 92%

Section: Discussioncontrasting

confidence: 85%

Association Between Symptom Duration and Patient‐Reported Outcomes Before and After Hip Replacement Surgery

Lau

Harrison

Sutton

2020

Arthritis Care & Research

Self Cite

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“…Two strands of literature shall be distinguished in the discussion of waiting times and outcomes. The first strand focuses on physical health conditions with most studies in the area of nonurgent surgical procedures such as hip and knee replacement (Braybrooke et al, 2007;Hamilton & Bramley-Harker, 1999;Hamilton, Hamilton, & Mayo, 1996;Hirvonen et al, 2007;Hirvonen et al, 2009;Ho, Hamilton, & Roos, 2000;Nikolova, Harrison, & Sutton, 2016;Quintana et al, 2011;Tuominen et al, 2009Tuominen et al, , 2010, or more urgent surgical procedures such as organ transplantation (Meier-Kriesche et al, 2000;Rauchfuss et al, 2013), and coronary artery bypass surgery (Manji, Jacobsohn, Grocott, & Menkis, 2013;Moscelli, Siciliani, & Tonei, 2016;Sari et al, 2007). Fewer studies investigate the relationship of waiting time with nonsurgical treatments such as rehabilitation (Collins, Suskin, Aggarwal, & Grace, 2015;Pedersen, Bogh, & Lauritsen, 2017), radiotherapy (Gupta, King, Korzeniowski, Wallace, & Mackillop, 2016;Noel et al, 2012;Seidlitz et al, 2015), or HIV treatment (Su et al, 2016).…”

Section: Related Literaturementioning

confidence: 99%

The impact of waiting time on patient outcomes: Evidence from early intervention in psychosis services in England

2018

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Recently, new emphasis was put on reducing waiting times in mental health services as there is an ongoing concern that longer waiting time for treatment leads to poorer health outcomes. However, little is known about delays within the mental health service system and its impact on patients. We explore the impact of waiting times on patient outcomes in the context of early intervention in psychosis (EIP) services in England from April 2012 to March 2015. We use the Mental Health Services Data Set and the routine outcome measure the Health of the Nation Outcome Scale. In a generalised linear regression model, we control for baseline outcomes, previous service use, and treatment intensity to account for possible endogeneity in waiting time. We find that longer waiting time is significantly associated with a deterioration in patient outcomes 12 months after acceptance for treatment for patients that are still in EIP care. Effects are strongest for waiting times longer than 3 months, and effect sizes are small to moderate. Patients with shorter treatment periods are not affected. The results suggest that policies should aim to reduce excessively long waits in order to improve outcomes for patients waiting for treatment for psychosis.

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“…91 In another example, a recent English NHS study found that waiting time for hip and knee replacement surgery had a statistically significant negative impact on the health gains from surgery. 92 Similar evidence on the impact of hospital waiting time has been found for other conditions, including chronic pain, 93 cataract 94 and heart transplantation. 95 We measure hospital waiting time in terms of days from outpatient decision-to-treat to inpatient admission-for-treatment.…”

Section: Hospital Waiting Timementioning

confidence: 57%

Health Equity Indicators for the English NHS: a longitudinal whole-population study at the small-area level

Cookson

Asaria

Ali

et al. 2016

Health Serv Deliv Res

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Background: Inequalities in health-care access and outcomes raise concerns about quality of care and justice, and the NHS has a statutory duty to consider reducing them. Objectives: The objectives were to (1) develop indicators of socioeconomic inequality in health-care access and outcomes at different stages of the patient pathway; (2) develop methods for monitoring local NHS equity performance in tackling socioeconomic health-care inequalities; (3) track the evolution of socioeconomic health-care inequalities in the 2000s; and (4) develop ‘equity dashboards’ for communicating equity findings to decision-makers in a clear and concise format. Design: Longitudinal whole-population study at the small-area level. Setting: England from 2001/2 to 2011/12. Participants: A total of 32,482 small-area neighbourhoods (lower-layer super output areas) of approximately 1500 people. Main outcome measures: Slope index of inequality gaps between the most and least deprived neighbourhoods in England, adjusted for need or risk, for (1) patients per family doctor, (2) primary care quality, (3) inpatient hospital waiting time, (4) emergency hospitalisation for chronic ambulatory care-sensitive conditions, (5) repeat emergency hospitalisation in the same year, (6) dying in hospital, (7) mortality amenable to health care and (8) overall mortality. Data sources: Practice-level workforce data from the general practice census (indicator 1), practice-level Quality and Outcomes Framework data (indicator 2), inpatient hospital data from Hospital Episode Statistics (indicators 3–6) and mortality data from the Office for National Statistics (indicators 6–8). Results: Between 2004/5 and 2011/12, more deprived neighbourhoods gained larger absolute improvements on all indicators except waiting time, repeat hospitalisation and dying in hospital. In 2011/12, there was little measurable inequality in primary care supply and quality, but inequality was associated with 171,119 preventable hospitalisations and 41,123 deaths amenable to health care. In 2011/12, > 20% of Clinical Commissioning Groups performed statistically significantly better or worse than the England equity benchmark. Limitations: General practitioner supply is a limited measure of primary care access, need in deprived neighbourhoods may be underestimated because of a lack of data on multimorbidity, and the quality and outcomes indicators capture only one aspect of primary care quality. Health-care outcomes are adjusted for age and sex but not for other risk factors that contribute to unequal health-care outcomes and may be outside the control of the NHS, so they overestimate the extent of inequality for which the NHS can reasonably be held responsible. Conclusions: NHS actions can have a measurable impact on socioeconomic inequality in both health-care access and outcomes. Reducing inequality in health-care outcomes is more challenging than reducing inequality of access to health care. Local health-care equity monitoring against a national benchmark can be performed using any admini...

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The Impact of Waiting Time on Health Gains from Surgery: Evidence from a National Patient‐reported Outcome Dataset

Cited by 52 publications

References 26 publications

Association Between Symptom Duration and Patient‐Reported Outcomes Before and After Hip Replacement Surgery

Association Between Symptom Duration and Patient‐Reported Outcomes Before and After Hip Replacement Surgery

The impact of waiting time on patient outcomes: Evidence from early intervention in psychosis services in England

Health Equity Indicators for the English NHS: a longitudinal whole-population study at the small-area level

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