title: Does waiting for total hip replacement matter? Prospective cohort study.
abstract: OBJECTIVE
  To assess the impact on the outcome of total hip replacement of the length of timing spent waiting for surgery.
  
  
  METHODS
  One hundred and forty-three orthopaedic and general hospitals provided information about aspects of surgical practice for each total hip replacement conducted between September 1996 and October 1997 for publicly and privately funded operations in five English health regions. These data were linked to patient information about hip-related pain and disability status (measured using the Oxford Hip Score) before operation and at 3 and 12 months after. Data were analysed using multiple regression analysis.
  
  
  RESULTS
  Questionnaires were completed by surgeons for 10,410 (78%) patients treated during the recruitment period and by 7151 (54%) patients. Twelve months after total hip replacement, the majority of patients experienced substantial improvements in hip-related pain and disability (as measured by the Oxford Hip Score). Those patients who started with a worse Oxford Hip Score before the operation tended to remain worse after the operation. Worse pre-operative score was associated with an increased length of either outpatient or inpatient wait, and this trend remained after the operation. The relationship between waiting time and outcome remained after adjustment for possible confounding variables. A consistently worse score was observed in public compared with private patients at all three time-points. In addition, in both sectors, those patients who were socially disadvantaged had a worse score than more socially advantaged patients both before and after the operation.
  
  
  CONCLUSIONS
  Waiting for surgery is associated with worse outcomes 12 months later. Longer-term outcome needs to be considered to see if this association persists.
authors.affiliation: Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK.
authors.forename: Shakoor
authors.initials: S
authors.lastname: Hajat
authors.forename: Ray
authors.initials: R
authors.lastname: Fitzpatrick
authors.forename: Richard
authors.initials: R
authors.lastname: Morris
authors.forename: Barnaby
authors.initials: B
authors.lastname: Reeves
authors.forename: Marianne
authors.initials: M
authors.lastname: Rigge
authors.forename: Olwen
authors.initials: O
authors.lastname: Williams
authors.forename: David
authors.initials: D
authors.lastname: Murray
authors.forename: Paul
authors.initials: P
authors.lastname: Gregg
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000534:rehabilitation*; D015331:Cohort Studies; D004185:Disability Evaluation; D004739:England; D005260:Female; D006801:Humans; D008131:London; D008297:Male; D008875:Middle Aged; D010003:Osteoarthritis / Q000601:surgery; D011183:Postoperative Complications; D020127:Recovery of Function; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome; D014850:Waiting Lists