The impact of pausing planned hip and knee surgery during winter pressures

The impact of pausing planned hip and knee surgery in a major NHS trust during the winter of 2017 are explored in a new ARC West paper published in BMJ Open.

In the winter of 2017, the NHS paused planned hip and knee surgery for two months because of winter pressures. This created a ‘natural experiment’ where we could look at trends for these surgeries before and after the pause at a major NHS Trust, between 2016 and 2019. We also looked at patient characteristics such as age, gender and social class.

A total of 2,623 patients had a hip replacement and 2,674 had a knee replacement at the Trust in the four-year period. The mean age of patients was 67 years and 60% were women for both types of operations.

The pause does appear to have had some impact on these surgeries. There was an immediate and sustained reduction in the number of knee replacements being done at the Trust and this was also reflected in a drop in bed occupancy for knee surgery.

The average age for knee replacement increased after winter 2017. More hip and knee surgery patients had multiple long-term conditions following the pause. The proportion of more deprived people having knee replacements decreased, and the ratio of public to private provision of hip and knee replacements dropped after winter 2017.

This suggests an NHS-funded outsourcing of younger and less complex hip and knee replacement surgery to independent private providers.

There was a general decrease in elective capacity, mostly driven by increasing non-elective admissions even before the COVID-19 pandemic. The winter 2017 cancellation may have been just one symptom of this overall pressure on planned surgery that underlies some of the longer-term changes in provision.

Tim Jones, NIHR ARC West Research Fellow and lead author of the paper, said:

“We were able to take advantage of this ‘natural experiment’ to understand how a pause like this could affect elective surgery afterwards. We saw a distinct shift towards private provision, with ‘easier’ surgeries – where the patients were younger or had fewer other conditions – being outsourced to the private sector. More research is needed to understand whether this is an acceptable solution that provides better care for patients.”

This project is part of the Health Data Research UK (HDR UK) Better Care South West Partnership.