The role of hospital organisation, surgical factors, and the enhanced recovery pathway, on patient outcomes and NHS costs following primary hip and knee replacement surgery: spatial and longitudinal analysis of routine data

Judge A, Carr A, Price A, Garriga C, Cooper C, Prieto-Alhambra D, Old F, Peat G, Murphy J, Leal J, Barker K, Underdown L, Arden N, Gooberman-Hill R, Fitzpatrick R, Drew S, Pritchard MG
Record ID 32016000610
Authors' objectives: Osteoarthritis is a leading cause of pain and disability. Many people with severe hip or knee pain caused by osteoarthritis have an operation called total joint replacement. This involves replacing the painful hip or knee joint with an artificial joint. Over 150,000 hip and knee replacement operations take place each year in the NHS and this number is expected to increase. In the NHS patients can choose which hospital they want to have their surgery in. Information on the outcomes of surgery between different hospitals would help patients in making their decision. Outcomes of surgery will vary across different hospitals and areas of the country. This may be explained by a hospital treating more complex and sicker patients, and this must be accounted for. However, differences in patient outcomes could also be explained by how hospitals organised their services, such as bed availability, numbers of operating theatres and specialist surgeons, using new surgical techniques, or centralising care into specialist high volume hospitals. Knowledge of this would help NHS managers to change the way services are organised and reduce variation in outcomes between hospitals. A new patient pathway for hip and knee replacement called enhanced recovery has been introduced in NHS and private hospitals. It is hoped this will benefit patients, through patient education before and after surgery, that includes making changes around the home, exercises to strengthen the joint and changes to diet, to help reduce the risk of complications and speed up a patient s recovery time. For patients in whom it is suitable, they will further benefit by being able to return home earlier to continue their recuperation at home with appropriate support. This in turn will benefit the hospital by freeing up space for other patients on the waiting list. However, hospitals organise enhanced recovery services in different ways and it is unclear which way is best. In this study we will identify whether the different ways that hospitals organise services for hip and knee replacement patients can lead to improved patient outcomes, and explain why outcomes vary between hospitals. We will produce maps highlighting how outcomes of surgery vary across the country. We will explore organisational processes in the way enhanced recovery has been implemented across different hospital settings. We will look at whether the introduction of enhanced recovery has improved patient outcomes and the potential cost saving to the NHS.
Project Status: Completed
Year Published: 2020
English language abstract: An English language summary is available
Publication Type: Not Assigned
Country: England
MeSH Terms
  • Arthroplasty, Replacement, Hip
  • Arthroplasty, Replacement, Knee
  • Data Collection
  • Health Care Quality, Access, and Evaluation
  • Costs and Cost Analysis
  • Hospital Medicine
  • Surgery Department, Hospital
  • Outcome Assessment, Health Care
  • Recovery of Function
Organisation Name: NIHR Health Services and Delivery Research programme
Contact Address: NIHR Journals Library, National Institute for Health Research, Evaluation, Trials and Studies Coordinating Centre, Alpha House, University of Southampton Science Park, Southampton SO16 7NS, UK
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Copyright: Queen's Printer and Controller of HMSO
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