PMID- 27356253
OWN - NLM
STAT- MEDLINE
DCOM- 20170518
LR  - 20170817
IS  - 1175-8716 (Electronic)
IS  - 0028-8446 (Linking)
VI  - 129
IP  - 1432
DP  - 2016 Apr 1
TI  - Rationing of hip and knee replacement: effect on the severity of patient-reported 
      symptoms and the demand for surgery in Otago.
PG  - 59-66
AB  - AIM: A key Government health target has been to increase access to elective 
      surgery. Despite this, there is a growing concern about unmet demand and 
      increasing numbers of patients are being declined elective surgery. This study 
      aims to determine whether there has been an increase in the severity of 
      osteoarthritis of the hip and knee in patients undergoing publicly-funded 
      elective total joint replacement (TJR) and any increase in demand for TJR in 
      Otago. METHOD: Demographic details and preoperative patient reported outcome 
      scores (Oxford hip or knee score (OHS,OKS) and a reduced Western Ontario and 
      McMaster Osteoarthritis Index (WOMAC) score (RWS) were collected prospectively in 
      an historical cohort of patients undergoing total hip and knee replacement (THR, 
      TKR) between 2006-2010. These were compared with all patients undergoing THR and 
      TKR in the 12-month period commencing 1 November 2013, and all patients 
      waitlisted during this period but returned to GP due to capacity issues. An 
      estimate of current demand was made by adding all waitlisted public patients from 
      the 12-month period to surgical numbers from private and those funded by ACC. 
      RESULTS: In the 2006-2010 group of 613 patients, the mean OHS was 13.6 (SD 6.7) 
      and OKS 15.4 (SD 6.5) and RWS 30.5 (SD 8.0). Three hundred and sixty-seven 
      patients who underwent surgery in 2013/4 had significantly poorer scores (OHS 9.9 
      (SD 4.9), OKS 10.6 (SD 3.8), RWS 34.8 (SD 6.7)). The scores of 194 patients 
      returned to GP in 2013/4 were the same as the historical surgical group (OHS13.0 
      (SD 6.2, OKS 15.2 (SD 5.9), RWS 30.8 (SD 8.4)). Six hundred and eight patients 
      were wait-listed for public surgery and 356 joints were performed in private or 
      under ACC in the 12-month period. The current intervention rate in Otago is 
      371/100,000 per year, while the demand has risen from 417/100000 in 2010-12 to 
      494/100,000 per year. In 2014, the shortfall was 241 joints per year. CONCLUSION: 
      Patients undergoing primary elective total hip and knee replacement in Otago in 
      2014 are more severely disabled than between 2006-2010. Patients currently being 
      returned to GP would have qualified for publicly funded surgery during that 
      period. The demand for elective TJR in Otago has increased by 19% since 2012.
FAU - Gwynne-Jones, David
AU  - Gwynne-Jones D
AD  - Surgical Sciences, Dunedin School of Medicine, University of Otago, Dunedin. 
      david.gwynne-jones@stonebow.otago.ac.nz.
FAU - Iosua, Ella
AU  - Iosua E
LA  - eng
PT  - Journal Article
DEP - 20160401
PL  - New Zealand
TA  - N Z Med J
JT  - The New Zealand medical journal
JID - 0401067
SB  - IM
MH  - Aged
MH  - Aged, 80 and over
MH  - Arthroplasty, Replacement, Hip/*statistics & numerical data
MH  - Arthroplasty, Replacement, Knee/*statistics & numerical data
MH  - Elective Surgical Procedures/*statistics & numerical data
MH  - Female
MH  - Health Services Needs and Demand/*statistics & numerical data
MH  - Humans
MH  - Male
MH  - New Zealand/epidemiology
MH  - Prospective Studies
EDAT- 2016/06/30 06:00
MHDA- 2017/05/19 06:00
CRDT- 2016/06/30 06:00
PHST- 2016/06/30 06:00 [entrez]
PHST- 2016/06/30 06:00 [pubmed]
PHST- 2017/05/19 06:00 [medline]
PST - epublish
SO  - N Z Med J. 2016 Apr 1;129(1432):59-66.