Major elective joint replacement surgery: socioeconomic variations in surgical risk, postoperative morbidity and length of stay

被引:43
|
作者
Hollowell, Jennifer [1 ]
Grocott, Mike P. W. [2 ]
Hardy, Rebecca [3 ]
Haddad, Fares S. [4 ]
Mythen, Monty G. [5 ]
Raine, Rosalind
机构
[1] UCL, Hlth Care Evaluat Grp, Dept Epidemiol & Publ Hlth, London WC1E 6BT, England
[2] Univ Coll London Hosp, Surg Outcome Res Ctr, Joint UCLH UCL Comprehens Biomed Res Ctr, London, England
[3] UCL, MRC Unit Lifelong Hlth & Ageing, London WC1E 6BT, England
[4] Univ Coll London Hosp, Dept Orthopaed, London, England
[5] Univ Coll London Hosp, UCL Ctr Anaesthesia, Dept Anaesthet, London, England
基金
英国医学研究理事会;
关键词
joint replacement; length of stay; socioeconomic factors; surgical complications; surgical risk; TOTAL HIP-REPLACEMENT; STANDING-COMMITTEE; KNEE ARTHROPLASTY; POSSUM SYSTEM; TASK-FORCE; INEQUALITIES; LIFE; RECOMMENDATIONS; OSTEOARTHRITIS; COMPLICATIONS;
D O I
10.1111/j.1365-2753.2009.01154.x
中图分类号
R19 [保健组织与事业(卫生事业管理)];
学科分类号
摘要
Background Patient deprivation is associated with greater need for total hip and knee replacement surgery (THR/TKR) and a higher prevalence of risk factors for surgical complications. Our aim was to examine associations between deprivation and aspects of the inpatient episode for patients undergoing these procedures. Methods We analysed socioeconomic variations in preoperative surgical risk, postoperative morbidity and length of stay for 655 patients undergoing elective THR/TKR at a large metropolitan hospital. Surgical risk was assessed using the orthopaedic version of the POSSUM scoring system, postoperative morbidity was assessed using the postoperative morbidity survey, and socioeconomic status was measured using the Index of Multiple Deprivation. We adjusted for age, sex, surgical site and primary vs. revision surgery. Results We found only a modest, clinically insignificant socioeconomic gradient in preoperative surgical risk and no socioeconomic gradient in postoperative morbidity. There was a strong socioeconomic gradient in length of stay, but only for patients undergoing TKR. This was due to deprived patients being more likely to remain in hospital without morbidity following TKR. Conclusions Our findings suggest differential selection of healthier patients for surgery. Hospitals serving deprived communities may have excess, unfunded costs because of the increased length of stay of socioeconomically disadvantaged patients.
引用
收藏
页码:529 / 538
页数:10
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