Waiting for total hip arthroplasty

Ostendorf, Marieke; Buskens, Erik; Stel, Henk F. van; Schrijvers, A. J. P.; Marting, Louis N.; Dhert, W.J.A.; Verbout, Abraham J.

doi:10.1016/j.arth.2003.09.015

Cited by 95 publications

(27 citation statements)

References 21 publications

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“…Possible contributing factors such as age and number of co-morbidities were similar for both groups (data not shown) and people awaiting TKR had a longer median waiting time (309 days for TKR versus 243 days for THR). Deterioration in HRQoL has also been reported in people awaiting THR in the Netherlands [9] and Sweden [15] using a different HRQoL utility measure, the EQ-5D. Other studies have investigated HRQoL in people awaiting joint replacement but cannot be directly compared with our findings.…”

Section: Discussionmentioning

confidence: 52%

“…Although the impact of longer waiting times has been unclear [14], several studies have reported deterioration in WOMAC pain and/or physical function subscale scores among people waiting for joint replacement. While these changes have been statistically significant, the mean changes in WOMAC scores have tended to be small [9,10,13,16]. In contrast, an earlier Canadian study found no change in WOMAC scores over the waiting period [8].…”

Section: Discussionmentioning

confidence: 99%

“…Kelly et al [8] reported improvements in SF-36 mental health and role emotional dimension scores for people awaiting TKR, while those awaiting THR did not change. In contrast, another study involving people waiting for THR found a small decline in SF-36 mental health scores [9]. More recently, McHugh et al [16] reported minimal deterioration in SF-36 mental health scores after 6 months of waiting for joint replacement, while role emotional scores improved.…”

Section: Discussionmentioning

confidence: 99%

“…As pre-operative wellbeing is an important predictor of joint replacement outcomes [9,17,18], knowledge of changes in health status represents valuable information for patients, clinicians and health policy makers and offers potential avenues for future interventions. To inform clinical practice and health policy, this study investigated changes in key indicators of wellbeing (HRQoL, health status, psychological distress and self-perceived change) among people awaiting THR or TKR.…”

Section: Introductionmentioning

confidence: 99%

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Decline in Health-Related Quality of Life reported by more than half of those waiting for joint replacement surgery: a prospective cohort study

Ackerman

Bennell

Osborne

2011

BMC Musculoskelet Disord

118

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BackgroundIn many healthcare systems, people with severe joint disease wait months to years for joint replacement surgery. There are little empirical data on the health consequences of this delay and it is unclear whether people with substantial morbidity at entry to the waiting list continue to deteriorate further while awaiting surgery. This study investigated changes in Health-Related Quality of Life (HRQoL), health status and psychological distress among people waiting for total hip (THR) and knee replacement (TKR) surgery at a major metropolitan Australian public hospital.Methods134 patients completed questionnaires including the Assessment of Quality of Life (AQoL) instrument, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Kessler Psychological Distress Scale after entering an orthopaedic waiting list (baseline) and before surgery (preadmission). To quantify potential decline in wellbeing, we calculated the proportion of people experiencing clinically important deterioration using published guidelines and compared HRQoL and psychological distress outcomes with population norms.ResultsMost participants (69%) waited ≥6 months for surgery (median 286 days, IQR 169-375 days). Despite poor physical and psychological wellbeing at baseline, there was an overall deterioration in HRQoL during the waiting period (mean AQoL change -0.04, 95%CI -0.08 to -0.01), with 53% of participants experiencing decline in HRQoL (≥0.04 AQoL units). HRQoL prior to surgery remained substantially lower than Australian population norms (mean sample AQoL 0.37, 95%CI 0.33 to 0.42 vs mean population AQoL 0.83, 95%CI 0.82 to 0.84). Twenty-five per cent of participants showed decline in health status (≥9.6 WOMAC units) over the waiting period and prevalence of high psychological distress remained high at preadmission (RR 3.5, 95%CI 2.8 to 4.5). Most participants considered their pain (84%), fatigue (76%), quality of life (73%) and confidence in managing their health (55%) had worsened while waiting for surgery.ConclusionsDespite substantial initial morbidity, over half of the participants awaiting joint replacement experienced deterioration in HRQoL during the waiting period. These data provide much-needed evidence to guide health professionals and policymakers in the design of care pathways and resource allocation for people who require joint replacement surgery.

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Section: Discussionmentioning

confidence: 52%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Decline in Health-Related Quality of Life reported by more than half of those waiting for joint replacement surgery: a prospective cohort study

Ackerman

Bennell

Osborne

2011

BMC Musculoskelet Disord

118

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“…2 Patients waiting for healthcare report more symptoms, poorer health, and reduced health-related quality of life compared to others, 3,4 and for some, the period of waiting is experienced as devastating. 5 Some will experience deterioration of health while waiting, 6 and some have reduced function and ability to work. For some conditions, outcome of treatment seems poorer among patients that have waited longer for care, 7 and researchers argue that waiting time should be taken into account when considering cost-effectiveness of care.…”

Section: Introductionmentioning

confidence: 99%

Long Waiting Times for Elective Hospital Care – Breaking the Vicious Circle by Abandoning Prioritisation

Sæther

Heggestad

Heimdal

et al. 2019

Int J Health Policy Manag

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Background: Policies assigning low-priority patients treatment delays for care, in order to make room for patients of higher priority arriving later, are common in secondary healthcare services today. Alternatively, each new patient could be granted the first available appointment. We aimed to investigate whether prioritisation can be part of the reason why waiting times for care are often long, and to describe how departments can improve their waiting situation by changing away from prioritisation. Methods: We used patient flow data from 2015 at the Department of Otorhinolaryngology, Haukeland University Hospital, Norway. In Dynaplan Smia, Dynaplan AS, dynamic simulations were used to compare how waiting time, size and shape of the waiting list, and capacity utilisation developed with and without prioritisation. Simulations were started from the actual waiting list at the beginning of 2015, and from an empty waiting list (simulating a new department with no initial patient backlog). Results: From an empty waiting list and with capacity equal to demand, waiting times were built 7 times longer when prioritising than when not. Prioritisation also led to poor resource utilisation and short-lived effects of extra capacity. Departments where prioritisation is causing long waits can improve their situation by temporarily bringing capacity above demand and introducing "first come, first served" instead of prioritisation. Conclusion: A poor appointment allocation policy can build long waiting times, even when capacity is sufficient to meet demand. By bringing waiting times down and going away from prioritisation, the waiting list size and average waiting times at the studied department could be maintained almost 90% below the current level – without requiring permanent change in the capacity/demand ratio.

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Severely compromised quality of life in women and those of lower socioeconomic status waiting for joint replacement surgery

Ackerman¹,

Graves²,

Wicks³

et al. 2005

Arthritis & Rheumatism

124

101

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Objective. To determine health-related quality of life (HRQOL), psychological distress, physical function, and self efficacy in persons waiting for lower-limb joint replacement surgery. Methods. A total of 214 patients on a waiting list for unilateral primary total knee or hip replacement at a large Australian public teaching hospital completed questionnaires after entry to the list. HRQOL and psychological distress were compared with available population norms. Results. Average HRQOL was extremely poor (mean ؎ SD 0.39 ؎ 0.24) and much lower (>2 SD) than the population norm. Near death-equivalent HRQOL or worse than death-equivalent HRQOL were reported by 15% of participants. High or very high psychological distress was up to 5 times more prevalent in the waiting list sample (relative risk 5.4 for participants ages 75 years and older; 95% confidence interval 3.3, 9.0). Women had significantly lower HRQOL, self efficacy, and physical function scores than men. After adjusting for age and sex, significant socioeconomic disparities were also found. Participants who received the lowest income had the poorest HRQOL; those with the least education or the lowest income had the highest psychological distress. Low self efficacy was moderately associated with poor HRQOL (r ‫؍‬ 0.49, P < 0.001) and more strongly associated with high psychological distress (r ‫؍‬ ؊0.55, P < 0.001). Conclusion. Patients waiting for joint replacement have very poor HRQOL and high psychological distress, especially women and those from lower socioeconomic backgrounds. Lengthy waiting lists mean patients can experience extended and potentially avoidable morbidity. Interventions to address psychological distress and self efficacy could reduce this burden and should target women and lower socioeconomic groups. KEY WORDS.Health-related quality of life; Joint replacement; Socioeconomic status.

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Waiting for total hip arthroplasty

Cited by 95 publications

References 21 publications

Decline in Health-Related Quality of Life reported by more than half of those waiting for joint replacement surgery: a prospective cohort study

Decline in Health-Related Quality of Life reported by more than half of those waiting for joint replacement surgery: a prospective cohort study

Long Waiting Times for Elective Hospital Care – Breaking the Vicious Circle by Abandoning Prioritisation

Severely compromised quality of life in women and those of lower socioeconomic status waiting for joint replacement surgery

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