Factors and consequences of waiting times for total hip arthroplasty.
BACKGROUND
Various priority criteria for waiting lists for THA have been proposed. These criteria, however, are not typically included in clinical practice, resulting in unclear management procedures. Further, the clinical effects of waiting times on subsequent pain control or function are unclear.


OBJECTIVE
Therefore, we asked (1) what factors affect the waiting time for THA when no prioritization criteria are implemented, and (2) does waiting time influence pain and function after THA?


METHODS
We prospectively identified all 1495 patients on a waiting list for THA during a year. Of these patients, 991 fulfilled the inclusion criteria, and waiting times were available for 695, of whom 527 (76%) responded to a followup questionnaire. Variables included wait time, sociodemographic data, comorbidities, and WOMAC and SF-36 questionnaires, collected preoperatively and 6 months after surgery.


RESULTS
The mean wait time was 5 months (SD, 3.0). Patients with lower levels of pain and better function on the WOMAC scale, or better physical function on the SF-36, had longer waiting times. The gains in function were smaller for patients who waited more than 6 months. The likelihood of perceiving a gain greater than the minimal clinically important difference was greater for patients waiting less than 3 months.


CONCLUSIONS
Only pain and previous function were significant determinants of prioritizing patients on the waiting list. Suboptimal patient selection had clinical consequences in function gain that affect the quality of the clinical care.
Basque Foundation for Health Innovation and Research (BIOEF), Pza. Asúa 1, Sondika, 48150 Bizkaia, Spain. vergara@bioef.org
Itziar
I
Vergara
Amaia
A
Bilbao
Nerea
N
Gonzalez
Antonio
A
Escobar
José M
JM
Quintana
D000368:Aged; D019644:Arthroplasty, Replacement, Hip; D004185:Disability Evaluation; D005260:Female; D006779:Hospitals, Public; D006784:Hospitals, Teaching; D006801:Humans; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D015207:Osteoarthritis, Hip / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D010147:Pain Measurement; D018579:Patient Selection; D011446:Prospective Studies; D011787:Quality of Health Care; D020127:Recovery of Function; D013030:Spain; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome; D014850:Waiting Lists
J Bone Joint Surg Am. 2006 Apr;88(4):685-91
16595456
Surg Clin North Am. 1983 Oct;63(5):1113-26
6356419
Ann Rheum Dis. 1999 Sep;58(9):569-72
10460191
J Bone Joint Surg Am. 1970 Apr;52(3):457-67
5425640
Med Care. 1992 Jun;30(6):473-83
1593914
Clin Rheumatol. 2005 Feb;24(1):29-37
15674656
Health Expect. 2007 Jun;10(2):108-16
17524004
Rheumatology (Oxford). 2002 Nov;41(11):1261-7
12421998
J Arthroplasty. 2004 Apr;19(3):302-9
15067641
Qual Health Care. 1996 Mar;5(1):20-30
10157268
J Rheumatol. 1995 Jun;22(6):1193-6
7674255
Osteoarthritis Cartilage. 2005 Dec;13(12):1076-83
16154777
J Rheumatol. 1988 Dec;15(12):1833-40
3068365
ANZ J Surg. 2003 Nov;73(11):926-8
14616572
CMAJ. 1995 Mar 1;152(5):687-97
7882231
Can J Surg. 2003 Aug;46(4):290-6
12930107
Arthritis Rheum. 1999 Aug;42(8):1722-8
10446873
Arthritis Rheum. 2002 Dec;46(12):3327-30
12483739
Health Policy. 2005 May;72(2):201-15
15802155
J Eval Clin Pract. 2003 Feb;9(1):23-31
12558699
J Chronic Dis. 1987;40(5):373-83
3558716
Rheumatology (Oxford). 2002 Apr;41(4):390-4
11961168
Pharmacoeconomics. 2000 Nov;18(5):419-23
11151395
Clin Rheumatol. 2002 Nov;21(6):466-71
12447629
J Health Serv Res Policy. 1996 Oct;1(4):224-31
10180875
Med Clin (Barc). 1995 May 27;104(20):771-6
7783470
J Health Serv Res Policy. 2002 Jan;7(1):19-25
11822257
Arch Intern Med. 2006 Jan 23;166(2):220-6
16432092
Arthritis Rheum. 2001 Oct;45(5):453-61
11642645
Ann Rheum Dis. 2001 Sep;60(9):834-40
11502609
J Clin Epidemiol. 2000 Dec;53(12):1200-8
11146265
Health Policy. 2003 Mar;63(3):229-37
12595123