Impact of pausing elective hip and knee replacement surgery during winter 2017 on subsequent service provision at a major NHS Trust: a descriptive observational study using interrupted time series.
| Title: | Impact of pausing elective hip and knee replacement surgery during winter 2017 on subsequent service provision at a major NHS Trust: a descriptive observational study using interrupted time series. |
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| Authors: | Jones T; NIHR ARC West, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK Timothy.Jones@bristol.ac.uk.; Musculoskeletal Research Unit, University of Bristol, Bristol, UK.; Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.; Penfold C; NIHR ARC West, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK.; Musculoskeletal Research Unit, University of Bristol, Bristol, UK.; Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.; Redaniel MT; NIHR ARC West, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK.; Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.; Eyles E; NIHR ARC West, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK.; Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.; Keen T; North Bristol NHS Trust, Westbury on Trym, Bristol, UK.; Elliott A; North Bristol NHS Trust, Westbury on Trym, Bristol, UK.; Blom AW; Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.; Judge A; Musculoskeletal Research Unit, University of Bristol, Bristol, UK. |
| Source: | BMJ open [BMJ Open] 2023 May 16; Vol. 13 (5), pp. e066398. Date of Electronic Publication: 2023 May 16. |
| Publication Type: | Observational Study; Journal Article; Research Support, Non-U.S. Gov't |
| Language: | English |
| Journal Info: | Publisher: BMJ Publishing Group Ltd Country of Publication: England NLM ID: 101552874 Publication Model: Electronic Cited Medium: Internet ISSN: 2044-6055 (Electronic) Linking ISSN: 20446055 NLM ISO Abbreviation: BMJ Open Subsets: MEDLINE |
| Imprint Name(s): | Original Publication: [London] : BMJ Publishing Group Ltd, 2011- |
| MeSH Terms: | Arthroplasty, Replacement, Hip*/adverse effects ; Arthroplasty, Replacement, Knee*/adverse effects; Humans ; State Medicine ; Interrupted Time Series Analysis ; Hospitalization |
| Abstract: | Objectives: To explore the impact of a temporary cancellation of elective surgery in winter 2017 on trends in primary hip and knee replacement at a major National Health Service (NHS) Trust, and whether lessons can be learnt about efficient surgery provision.; Design and Setting: Observational descriptive study using interrupted time series analysis of hospital records to explore trends in primary hip and knee replacement surgery at a major NHS Trust, as well as patient characteristics, 2016-2019.; Intervention: A temporary cancellation of elective services for 2 months in winter 2017.; Outcomes: NHS-funded hospital admissions for primary hip or knee replacement, length of stay and bed occupancy. Additionally, we explored the ratio of elective to emergency admissions at the Trust as a measure of elective capacity, and the ratio of public to private provision of NHS-funded hip and knee surgery.; Results: After winter 2017, there was a sustained reduction in the number of knee replacements, a decrease in the proportion of most deprived people having knee replacements and an increase in average age for knee replacement and comorbidity for both types of surgery. The ratio of public to private provision dropped after winter 2017, and elective capacity generally has reduced over time. There was clear seasonality in provision of elective surgery, with less complex patients admitted during winter.; Conclusions: Declining elective capacity and seasonality has a marked effect on the provision of joint replacement, despite efficiency improvements in hospital treatment. The Trust has outsourced less complex patients to independent providers, and/or treated them during winter when capacity is most limited. There is a need to explore whether these are strategies that could be used explicitly to maximise the use of limited elective capacity, provide benefit to patients and value for money for taxpayers.; (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY. Published by BMJ.) |
| Competing Interests: | Competing interests: TJ, EE and MTR had financial support from NIHR ARC West for the submitted work. AJ has had financial support in the previous 3 years through institutional grants from NIHR, HDR UK, Versus Arthritis, Healthcare Quality Improvement Partnership (HQIP), Royal College of Physicians (RCP) and Health Foundation, had unpaid committee or leadership roles relating to musculoskeletal conditions for NIHR, Nuffield Foundation, Warwick CTU, and Versus Arthritis and a paid expert panel role for Nuffield Foundation Oliver Bird Fund; no other financial relationships with any organisations that might have an interest in the submitted work in the previous 3 years; no other relationships or activities that could appear to have influenced the submitted work. |
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| Grant Information: | United Kingdom DH_ Department of Health |
| Contributed Indexing: | Keywords: Hip; Human resource management; Knee; Orthopaedic & trauma surgery |
| Entry Date(s): | Date Created: 20230516 Date Completed: 20230518 Latest Revision: 20230526 |
| Update Code: | 20260130 |
| PubMed Central ID: | PMC10193088 |
| DOI: | 10.1136/bmjopen-2022-066398 |
| PMID: | 37192798 |
| Database: | MEDLINE |
Observational Study; Journal Article; Research Support, Non-U.S. Gov't