The impact of the 6-month waiting target for elective surgery: a patient record study.
OBJECTIVE
To quantify the number of patients declined surgery due to scoring below the financial threshold, when presenting for total hip or total knee arthroplasty at two New Zealand District Health Boards (DHBs).


METHODS
Data from patients presenting with hip or knee osteoarthritis at both Whangarei Base Hospital and Hawke's Bay Regional Hospital from June 2012 to June 2013 were reviewed. Data were taken from hospital codes and patient records. The outcome from clinic visits were recorded as well as the patient's New Zealand Orthopaedic Association (NZOA) prioritisation score.


RESULTS
A total of 1202 patient records were reviewed: 393 from Whangarei Base Hospital and 809 from Hawke's Bay Regional Hospital. Of the 858 patients where surgery was both desired by the patient and deemed appropriate by the surgeon, 307 (36%) were declined for being below the financial threshold. These patients had a mean NZOA score of 66.42. At Whangarei Base Hospital, 300 patients were referred for surgery and 98 (33%) were declined for being below threshold. The mean NZOA score was significantly higher in the patients booked for surgery (M=70.62) compared with those declined below threshold (M=55.39, p<0.001). Of the 497 patients referred for arthroplasty at Hawke's Bay Regional Hospital, 205 (41%) were declined for being below threshold. The mean NZOA prioritisation scores were also significantly higher in the patients booked for surgery (M=76.96) compared to those declined (M=64.66; p less than or equal to 0.001).


CONCLUSIONS
36% of patients who were suitable for hip or knee arthroplasty were declined elective surgery for being below threshold. Many of these patients have significant pain and disability.
Department of Orthopaedics, Hastings Regional Hospital, Omahu Road, Private Bag 9014, Hastings 4120, New Zealand. jblackett@gmail.com.
James
J
Blackett
Alex
A
Carslaw
David
D
Lees
Sophie
S
Fargher
Sudhindra
S
Rao
Margy
M
Pohl
D019644:Arthroplasty, Replacement, Hip / Q000191:economics / Q000592:standards* / Q000706:statistics & numerical data; D019645:Arthroplasty, Replacement, Knee / Q000191:economics / Q000592:standards* / Q000706:statistics & numerical data; D004185:Disability Evaluation; D017558:Elective Surgical Procedures / Q000191:economics / Q000592:standards* / Q000706:statistics & numerical data; D015276:Health Care Rationing / Q000191:economics / Q000592:standards* / Q000706:statistics & numerical data; D006305:Health Status Indicators; D006801:Humans; D009313:National Health Programs / Q000191:economics / Q000592:standards* / Q000706:statistics & numerical data; D009520:New Zealand; D015207:Osteoarthritis, Hip / Q000191:economics / Q000601:surgery*; D020370:Osteoarthritis, Knee / Q000191:economics / Q000601:surgery*; D010147:Pain Measurement; D012017:Referral and Consultation; D014850:Waiting Lists