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Major elective joint replacement surgery: socioeconomic variations in surgical risk, postoperative morbidity and length of stay

Major elective joint replacement surgery: socioeconomic variations in surgical risk, postoperative morbidity and length of stay
Major elective joint replacement surgery: socioeconomic variations in surgical risk, postoperative morbidity and length of stay
BACKGROUND: Patient deprivation is associated with greater need for total hip and knee replacement surgery (THR/TKR) and a higher prevalence of risk factors for surgical complications. Our aim was to examine associations between deprivation and aspects of the inpatient episode for patients undergoing these procedures.

METHODS: We analysed socioeconomic variations in preoperative surgical risk, postoperative morbidity and length of stay for 655 patients undergoing elective THR/TKR at a large metropolitan hospital. Surgical risk was assessed using the orthopaedic version of the POSSUM scoring system, postoperative morbidity was assessed using the postoperative morbidity survey, and socioeconomic status was measured using the Index of Multiple Deprivation. We adjusted for age, sex, surgical site and primary vs. revision surgery.

RESULTS: We found only a modest, clinically insignificant socioeconomic gradient in preoperative surgical risk and no socioeconomic gradient in postoperative morbidity. There was a strong socioeconomic gradient in length of stay, but only for patients undergoing TKR. This was due to deprived patients being more likely to remain in hospital without morbidity following TKR.

CONCLUSIONS: Our findings suggest differential selection of healthier patients for surgery. Hospitals serving deprived communities may have excess, unfunded costs because of the increased length of stay of socioeconomically disadvantaged patients.

joint replacement, length of stay, socioeconomic factors, surgical complications, surgical risk
1356-1294
529-538
Hollowell, Jennifer
4e9777d2-9c30-412c-b558-8bd0057e8040
Grocott, Mike P.W.
1e87b741-513e-4a22-be13-0f7bb344e8c2
Hardy, Rebecca
99fecbaf-fc92-4354-aa02-cb904dd2bd32
Haddad, Fares S.
cf7e5211-5ff2-477b-96de-34f76a08c3a8
Mythen, Monty G.
266ffcca-f8dd-49b4-abe4-0ffb035e2b35
Raine, Rosalind
fe76e3f8-b410-4370-9a74-37135c20a8b3
Hollowell, Jennifer
4e9777d2-9c30-412c-b558-8bd0057e8040
Grocott, Mike P.W.
1e87b741-513e-4a22-be13-0f7bb344e8c2
Hardy, Rebecca
99fecbaf-fc92-4354-aa02-cb904dd2bd32
Haddad, Fares S.
cf7e5211-5ff2-477b-96de-34f76a08c3a8
Mythen, Monty G.
266ffcca-f8dd-49b4-abe4-0ffb035e2b35
Raine, Rosalind
fe76e3f8-b410-4370-9a74-37135c20a8b3

Hollowell, Jennifer, Grocott, Mike P.W., Hardy, Rebecca, Haddad, Fares S., Mythen, Monty G. and Raine, Rosalind (2010) Major elective joint replacement surgery: socioeconomic variations in surgical risk, postoperative morbidity and length of stay Journal of Evaluation in Clinical Practice, 16, (3), pp. 529-538. (doi:10.1111/j.1365-2753.2009.01154.x). (PMID:20210822).

Record type: Article

Abstract

BACKGROUND: Patient deprivation is associated with greater need for total hip and knee replacement surgery (THR/TKR) and a higher prevalence of risk factors for surgical complications. Our aim was to examine associations between deprivation and aspects of the inpatient episode for patients undergoing these procedures.

METHODS: We analysed socioeconomic variations in preoperative surgical risk, postoperative morbidity and length of stay for 655 patients undergoing elective THR/TKR at a large metropolitan hospital. Surgical risk was assessed using the orthopaedic version of the POSSUM scoring system, postoperative morbidity was assessed using the postoperative morbidity survey, and socioeconomic status was measured using the Index of Multiple Deprivation. We adjusted for age, sex, surgical site and primary vs. revision surgery.

RESULTS: We found only a modest, clinically insignificant socioeconomic gradient in preoperative surgical risk and no socioeconomic gradient in postoperative morbidity. There was a strong socioeconomic gradient in length of stay, but only for patients undergoing TKR. This was due to deprived patients being more likely to remain in hospital without morbidity following TKR.

CONCLUSIONS: Our findings suggest differential selection of healthier patients for surgery. Hospitals serving deprived communities may have excess, unfunded costs because of the increased length of stay of socioeconomically disadvantaged patients.

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More information

e-pub ahead of print date: 18 February 2010
Published date: June 2010
Keywords: joint replacement, length of stay, socioeconomic factors, surgical complications, surgical risk
Organisations: Human Development & Health

Identifiers

Local EPrints ID: 348911
URI: http://eprints.soton.ac.uk/id/eprint/348911
ISSN: 1356-1294
PURE UUID: 037ec049-62cf-4456-a60c-8369c07ab8c6

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Date deposited: 25 Feb 2013 10:47
Last modified: 18 Jul 2017 04:46

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Contributors

Author: Jennifer Hollowell
Author: Rebecca Hardy
Author: Fares S. Haddad
Author: Monty G. Mythen
Author: Rosalind Raine

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