Total joint replacement: implication of cancelled operations for hospital costs and waiting list management.
OBJECTIVE
To identify aspects of provision of total joint replacements which could be improved.


METHODS
10 month prospective study of hospital admissions and hospital costs for patients whose total joint replacement was cancelled.


METHODS
Information and Waiting List Unit, Musgrave Park Regional Orthopaedic Service, Belfast.


METHODS
284 consecutive patients called for admission for total joint replacement.


METHODS
Costs of cancellation of operation after admission in terms of hotel and opportunity costs.


RESULTS
28(10%) planned operations were cancelled, 27 of which were avoidable cancellations. Five replacement patients were substituted on the theatre list, leaving 22(8%) of 232 operating theatre opportunities unused. Patients seen at assessment clinics within two months before admission had a significantly higher operation rate than those admitted from a routine waiting list (224/232(97%) v 32/52(62%), x2 = 58.6, df = 1; p < 0.005). Mean duration of hospital stay in 28 patients with cancelled operations was 1.92 days. Operating theatre opportunity costs were 73% of the total costs of cancelled total joint replacements.


CONCLUSIONS
Patients on long waiting lists for surgery should be reassessed before admission to avoid wasting theatre opportunities, whose cost is the largest component of the total costs of cancelled operations.
Musgrave Park Regional, Belfast, Northern Ireland.
J L
JL
Mangan
C
C
Walsh
W G
WG
Kernohan
J S
JS
Murphy
R A
RA
Mollan
R
R
McMillen
D E
DE
Beverland
D003625:Data Collection; D017721:Hospital Costs / Q000706:statistics & numerical data; D006801:Humans; D007595:Joint Prosthesis / Q000191:economics*; D009660:Northern Ireland; D009873:Operating Rooms / Q000191:economics / Q000706:statistics & numerical data*; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D018579:Patient Selection; D011446:Prospective Studies; D013503:Surgery Department, Hospital / Q000191:economics / Q000706:statistics & numerical data; D014850:Waiting Lists