The practice of selecting patients with a low ASA(American Society of Anesthesiologists) grade to have joint replacement performed at remote centres such as DTCs (Diagnosis and Treatment Centres) and by teams of visiting surgeons is becoming more commonplace. This leaves NHS Hospitals with a patient population skewed towards the higher ASA grades. This study was undertaken to identify the extra burden that this may place on a District General Hospital.

All patients undergoing total hip or knee arthroplasty at Blackpool Victoria Hospital in the year 2002 were identified. Of 191 patients, 132 were classified as ASA grade I or II. 59 patients (31%) were classified as ASA grade III or IV. The immediate postoperative complication rate for the patients with ASA grade III and IV was found to be 25%. All complications were treated appropriately and all patients had a satisfactory outcome at 6 weeks. The reported immediate postoperative complication rate for hip and knee replacement ranges from 3–6%. It is clear from these figures that removal of fitter patients from waiting lists will effectively increase the complication rate following arthroplasty in NHS Hospitals. We feel that the Government has not identified the extra care involved in treating these higher risk patients.