Abstract
Cite this article: Bone Joint Res 2022;11(12):890–892.
Cessation of routine surgical activity during the COVID-19 pandemic has led to a substantial backlog of patients waiting for orthopaedic surgery, with an associated substantial deterioration in surgical waiting times.1,2
Prolonged waits for certain orthopaedic procedures can have a major negative impact on patient health.3 This occurs in terms of deterioration in quality of life while awaiting surgery, as well as potential negative connotations for postoperative recovery and longer-term health in addition to reduced independence and increased social care needs.4,5
Predicted waiting times for routine orthopaedic surgery in a public healthcare system have been calculated using routinely available data.6 This includes assessment of potential changes in future operative activity (for example, additional capacity provided through the proposed launch of National Treatment Centres (NTCs) in 2023) and ability to achieve current national targets.
Key findings include a notable current annual case deficit that will not be resolved even with a return to pre-COVID-19 activity coupled with a 22% uplift in capacity (i.e. the full additional planned NTCs’ capacity). This is even before consideration of increased future demand for hip and knee arthroplasty services, predicted to rise from pre-COVID-19 levels by up to 28% and 34% in 2038, respectively.7
As the rate at which patients are being added to the waiting list exceeds the rate they are being taken off it, any delay results in a subsequent rise in waiting times (i.e. based on current activity for every month of delay in providing this necessary surgical capacity, there is an over one-month increase in a new patient’s waiting time), which further highlights the urgency of a return to pre-COVID-19 orthopaedic activity, as well as the realization of the 22% uplift from the full additional NTC capacity.
However, even in the best-case scenario the average wait across Scotland would be 1.3 years for a patient listed in July 2022, compared to 2.3 years for the worst-case scenario. Given that current admissions for routine treatment are only 52.2% of 2019 activity, a return to a pre-COVID-19 level of operative output will require a substantial change from current practice.
The study highlights the great challenges facing recovery of planned orthopaedic surgery following the pandemic. If the barriers to notable expansion of current activity are not addressed urgently, then waiting lists will continue to deteriorate and patients will continue to come to harm as a result.
Further work is now warranted to provide more granular understanding of waiting times for individual procedures, particularly given previous evidence that has highlighted large disparities between available day-case and inpatient capacity that were analyzed collectively in this study.8
References
1. COVIDSurg Collaborative . Elective surgery cancellations due to the COVID-19 pandemic: global predictive modelling to inform surgical recovery plans . Br J Surg . 2020 ; 107 ( 11 ): 1440 – 1449 . Crossref PubMed Google Scholar
2. Carr A , Smith JA , Camaradou J , Prieto-Alhambra D . Growing backlog of planned surgery due to covid-19 . BMJ . 2021 ; 372 : n339 . Crossref PubMed Google Scholar
3. Clement ND , Scott CEH , Murray JRD , Howie CR , Deehan DJ , IMPACT-Restart Collaboration . The number of patients “worse than death” while waiting for a hip or knee arthroplasty has nearly doubled during the COVID-19 pandemic . Bone Joint J . 2021 ; 103-B ( 4 ): 672 – 680 . Crossref Google Scholar
4. Ostendorf M , Buskens E , van Stel H , et al. Waiting for total hip arthroplasty: avoidable loss in quality time and preventable deterioration . J Arthroplasty . 2004 ; 19 ( 3 ): 302 – 309 . Crossref PubMed Google Scholar
5. Nikolova S , Harrison M , Sutton M . The impact of waiting time on health gains from surgery: Evidence from a national patient-reported outcome dataset . Health Econ . 2016 ; 25 ( 8 ): 955 – 968 . Crossref PubMed Google Scholar
6. No authors listed . NHS waiting times - stage of treatment . Public Health Scotland . 2022 . https://publichealthscotland.scot/publications/nhs-waiting-times-stage-of-treatment/stage-of-treatment-waiting-times-inpatients-day-cases-and-new-outpatients-30-june-2022/clinical-prioritisation-dashboard/ ( date last accessed 18 November 2022 ). Google Scholar
7. Farrow L , McLoughlin J , Gaba S , Ashcroft GP . Future demand for primary hip and knee arthroplasty in Scotland . Musculoskeletal Care . 2022; Epub ahead of print . Crossref PubMed Google Scholar
8. Hampton M , Riley E , Garneti N , Anderson A , Wembridge K . The orthopaedic waiting list crisis: two sides of the story . Bone Jt Open . 2021 ; 2 ( 7 ): 530 – 534 . Crossref Google Scholar
Author contributions
L. Farrow: Conceptualization, Data curation, Formal analysis, Investigation, Methodology, Project administration, Visualization, Writing – original draft, Writing – review & editing.
P. J. Jenkins: Supervision, Writing – review & editing.
E. Dunstan: Supervision, Writing – review & editing.
A. Murray: Supervision, Writing – review & editing.
M. J. G. Blyth: Supervision, Writing – review & editing.
A. H. R. W. Simpson: Writing – review & editing.
N. D. Clement: Methodology, Validation, Writing – review & editing.
Funding statement
The authors received no financial or material support for the research, authorship, and/or publication of this article.
ICMJE COI statement
L. Farrow reports that this study will be included in a PhD submission as part of the Chief Scientist Office Clinical Academic Fellowship, and that no funding was provided specifically for this study.
Acknowledgements
We are grateful to the team at Public Health Scotland behind the clinical prioritization dashboard for open provision of the data utilized in this study.
Follow P. J. Jenkins @pjjenkins80
Follow E. Dunstan @balhousie
Follow M. J G. Blyth @GriOrtho
Supplementary material
Further details on the study methodology, as well as individual health board calculations regarding predicted waiting times for surgery and associated case deficits (including sensitivity estimates).
© 2022 Author(s) et al. This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives (CC BY-NC-ND 4.0) licence, which permits the copying and redistribution of the work only, and provided the original author and source are credited. See https://creativecommons.org/licenses/by-nc-nd/4.0/
