The number of patients "worse than death" while waiting for a hip or knee arthroplasty has nearly doubled during the COVID-19 pandemic: a UK nationwide survey. (1st April 2021)

• Record Type: Journal Article
• Authors: Clement, Nick D.; Scott, Chloe E. H.; Murray, James R. D.; Howie, Colin R.; Deehan, David J.
• Is Part Of: Bone & joint journal. Volume 103B:Number 4(2021)
• Page Start: 672
• Page End: 680
• Publication Date: 2021-04-01
• Subjects: Arthroplasty -- COVID-19 -- Worse than death -- Quality of life -- Waiting list; knee arthroplasty procedure -- COVID-19 pandemic -- Hip -- EuroQoL (EQ) -- arthroplasty surgery -- t-test -- visual analogue scale (VAS) -- total hip and knee arthroplasty -- total hip or knee arthroplasty -- hip and knee arthroplasty; Bones -- Surgery -- Periodicals; Joints -- Surgery -- Periodicals; Orthopedic surgery -- Periodicals; 617.47005
• DOI: 10.1302/0301-620X.103B.BJJ-2021-0104.R1
• Languages: English
• ISSNs: 2049-4394

Abstract

Abstract : Aims: The aim of this study was to assess the quality of life of patients on the waiting list for a total hip (THA) or knee arthroplasty (KA) during the COVID-19 pandemic. Secondary aims were to assess whether length of time on the waiting list influenced quality of life and rate of deferral of surgery. Methods: During the study period (August and September 2020) 843 patients (THA n = 394, KA n = 449) from ten centres in the UK reported their EuroQol five dimension (EQ-5D) scores and completed a waiting list questionnaire (2020 group). Patient demographic details, procedure, and date when listed were recorded. Patients scoring less than zero for their EQ-5D score were defined to be in a health state "worse than death" (WTD). Data from a retrospective cohort (January 2014 to September 2017) were used as the control group. Results: The 2020 group had a significantly worse EQ-5D score compared to the control group for both THA (p < 0.001) and KA (p < 0.001). Over one-third (35.0%, n = 138/394) of patients waiting for a THA and nearly a quarter (22.3%, n = 100/449) for KA were in a health state WTD, which was significantly greater than the control group (odds ratio 2.30 (95% confidence interval (CI) 1.83 to 2.93) and 2.08 (95% CI 1.61 to 2.70), respectively; p < 0.001). Over 80% (n = 680/843) of the 2020 group felt that their quality of life had deteriorated while waiting. Each additional month spent on the waiting list was independently associated with a decrease in quality of life (EQ-5D: -0.0135, p = 0.004). There were 117 (13.9%) patients who wished to defer their surgery and the main reason for this was health concerns for themselves and or their family (99.1%, n = 116/117). Conclusion: Over one-third of patients waiting for THA and nearly one-quarter waiting for a KA were in a state WTD, which was approaching double that observed prior to the pandemic. Increasing length of time on the waiting list was associated with decreasing quality of life. Level of evidence: Level III retrospective case control study Cite this article: Bone Joint J 2021;103-B(4):672–680.