title: Patient psychological characteristics have minimal influence on surgical prioritization.
abstract: OBJECTIVE
  Rationing of health care is universal in systems free at the point of delivery. United Kingdom National Health Service (NHS) policy is for treatment on the basis of "clinical need." Surgeons routinely prioritize elective cases, and structured assessments of symptom severity have been suggested as a rational method of prioritization. We hypothesized that patient psychological factors would play an important role in prioritization as currently practiced.
  
  
  METHODS
  Two hundred thirty participants were recruited from a potential pool of 259 eligible referrals to an orthopaedic department for assessment of lower limb arthroplasty. Participants were assessed at time of referral and followed for 2.5 years. Associations were estimated between participant's psychological distress, illness perceptions, and the outcome of surgical prioritization.
  
  
  RESULTS
  One hundred forty-one participants were listed for arthroplasty; 62 (44%) of these were considered urgent cases. Pain was the only univariate predictor of this outcome. Patient's psychological distress and illness perceptions were not associated with being classified as urgent even after adjusting for clinical and demographic status. In a multivariate model, only older age showed an independent effect (OR 2.75, 95% CI 1.14, 6.66) of increasing the chances of being considered urgent. Urgent cases had a 3-month-shorter inpatient wait among the 108 participants operated on during the study.
  
  
  CONCLUSIONS
  The psychological status of arthroplasty candidates had no significant effect on the surgical prioritization process. Allocation to the urgent list appears to be based primarily on the patient's age, but is partially influenced by patient's better physical health and viewing treatment as being effective.
authors.affiliation: Institute of Psychiatry, London, UK. n.glozier@iop. kcl.ac.uk
authors.forename: Nick
authors.initials: N
authors.lastname: Glozier
authors.forename: Graeme
authors.initials: G
authors.lastname: Groom
authors.forename: Martin
authors.initials: M
authors.lastname: Prince
mesh_terms: D019643:Arthroplasty, Replacement / Q000523:psychology; D001291:Attitude of Health Personnel; D001294:Attitude to Health; D005260:Female; D015276:Health Care Rationing; D006304:Health Status; D006801:Humans; D008297:Male; D010147:Pain Measurement / Q000379:methods; D018579:Patient Selection; D010551:Personality / Q000145:classification*; D012720:Severity of Illness Index; D012803:Sick Role; D013222:State Medicine; D013315:Stress, Psychological / Q000175:diagnosis; D006113:United Kingdom; D014850:Waiting Lists