The COVID pandemic has been a huge challenge for the nation’s health. Accessing healthcare has been difficult for many, especially those requiring ‘elective’ surgery. Orthopaedic surgery has experienced the greatest reduction in operating volume of all surgical disciplines. When NHS beds are pressured, orthopaedics stops first.
One reason for this is a misperception that operations such as hip and knee replacements are somehow optional or lifestyle related and that our patients can wait indefinitely, as after all, it won’t kill them.
Surgical waiting lists were a problem before the pandemic. They are now at unprecedented levels and getting worse. Even by increasing operating rates by a fifth, it will take 4-5 years to clear the backlog of patients needing joint replacements created by the reduction in surgery during the pandemic.
Healthcare systems decide how to spend money based on the cost-effectiveness of a treatment: how much improvement in health-related quality of life a patient gets for what cost. Hip and knee replacements are some of the most cost-effective treatments in all of medicine.
Worse than death
To measure health-related quality of life a scoring system is used. These scores have been ranked by members of the UK general public to say how long they would be happy to live in that particular health state. Some of these health states are ranked ‘worse than death’ – members of the UK general public would rather be dead than live with health that bad.
Our study across ten sites in Scotland, England and Wales during the pandemic found that 35% of patients waiting for a hip replacement and nearly a quarter waiting for a knee replacement are currently in a ‘worse than death’ health state. These patients have severe and constant pain, often preventing them from working or sleeping and requiring increasing amounts of strong – potentially addictive – painkillers. Many have become housebound because of the severity of their arthritis. This suffering is reversed by joint replacements.
Longer waits make the problem worse: the longer you wait the worse your health-related quality of life becomes. It also affects your joint replacement outcome – being ‘worse than death’ significantly worsens the outcome of surgery.
Performing joint replacements in the pandemic is safe, as shown by numerous studies. We urgently need to restart orthopaedic surgery and to do so at high volume. A robust, coherent and efficient plan for the tens of thousands of patients waiting for life-changing and pain-relieving surgery must be a priority. Not to do so is a false economy. A National Health Service must be able to provide health to its nation.
This article originally appeared in The Times on 24 March 2021
Image credit: Getty/stockdevil
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