The orthopaedic waiting list crisis

Abstract

Aims Due to widespread cancellations in elective orthopaedic procedures, the number of patients on waiting list for surgery is rising. We aim to determine and quantify if disparities exist between inpatient and day-case orthopaedic waiting list numbers; we also aim to determine if there is a ‘hidden burden’ that already exists due to reductions in elective secondary care referrals. Methods Retrospective data were collected between 1 April 2020 and 31 December 2020 and compared with the same nine-month period the previous year. Data collected included surgeries performed (day-case vs inpatient), number of patients currently on the orthopaedic waiting list (day-case vs inpatient), and number of new patient referrals from primary care and therapy services. Results There was a 52.8% reduction in our elective surgical workload in 2020. The majority of surgeries performed in 2020 were day case surgeries (739; 86.6%) with 47.2% of these performed in the independent sector on a ‘lift and shift’ service. The total number of patients on our waiting lists has risen by 30.1% in just 12 months. As we have been restricted in performing inpatient surgery, the inpatient waiting lists have risen by 73.2%, compared to a 1.6% rise in our day-case waiting list. New patient referral from primary care and therapy services have reduced from 3,357 in 2019 to 1,722 in 2020 (49.7% reduction). Conclusion This study further exposes the increasing number of patients on orthopaedic waiting lists. We observed disparities between inpatient and day-case waiting lists, with dramatic increases in the number of inpatients on the waiting lists. The number of new patient referrals has decreased, and we predict an influx of referrals as the pandemic eases, further adding to the pressure on inpatient waiting lists. Robust planning and allocation of adequate resources is essential to deal with this backlog. Cite this article: Bone Jt Open 2021;2(7):530–534.

Autologous versus synthetic bone grafts for the surgical management of tibial plateau fractures: a systematic review and meta-analysis of randomized controlled trials

“…Blood loss is a key surgical morbidity, and reduced duration of surgery impacts provision of both orthopaedic and anaesthetic services, especially given widespread increased systemic pressures around the COVID-19 pandemic, the additional morbidity associated with prolonged anaesthesia, and environmental concerns surrounding inhaled anaesthetics. [54][55][56][57] Three studies reported on mechanical alignment, which may be predictive of impaired long-term functionality and subsequent development of osteoarthritis, at follow-up, and concluded there was no difference in alignment between synthetic and autologous bone grafts. 32,33,35,47,58 Functional outcome data in our evidence base was limited and showed no preference for synthetic or autologous bone grafts.…”

“…Blood loss is a key surgical morbidity, and reduced duration of surgery impacts provision of both orthopaedic and anaesthetic services, especially given widespread increased systemic pressures around the COVID-19 pandemic, the additional morbidity associated with prolonged anaesthesia, and environmental concerns surrounding inhaled anaesthetics. 54 - 57 …”

Did we do it right? The effect of postponing elective orthopedic surgeries due to the pandemic on the quality of life

“…During the pandemic of our age, elective surgeries have been ceased in most countries to reduce hospital admissions and to direct facilities to pandemic patients (6,8,9,(12)(13)(14). In orthopedics, especially patients who are waiting for knee and hip arthroplasties are affected by this situation, and they are forced to live with a very low quality of life, which is described as "worse than death" situation in the literature (7,8).…”

The Impact of Harm Review Service on Patients Awaiting Elective Orthopaedic Foot and Ankle Surgery for More Than 52 Weeks

“…A significant drop in the elective surgical output across specialities was observed during the year 2020 due to resources being diverted to tackling the coronavirus disease 2019 (COVID-19) crisis [ 1 ]. This has led to a significant number of patients being forced to wait an inordinate amount of time to receive elective treatments in trauma and orthopaedic surgery.…”