Abstract
Aim: To analyse the Dunedin residual orthopaedic waiting list based on a simple patient questionnaire and a quality of life assessment using EuroQol and SF12.
Method: All patients on the residual waiting list were sent a postal questionnaire enquiring about their need for surgery and their quality of life. Based on their answers, patients were entered into three action groups: 1. back to GP care 2. clinical review 3. booked for surgery. Those patients requiring a clinical review were seen in a special clinic and reassessed in relation to their need for surgery.
Results: Two hundred and sixty-one patients were surveyed. One hundred and fifty-eight had complete data available for analysis and of the remaining 103 patients, 88 were taken off the waiting list for various reasons. Fifteen did not reply. The average time on the waiting list was 19 months (range: < six months to eight years). Sixty percent of the patients felt that their condition had changed and 99% felt that they still required the surgery. The results of the EuroQol and DF12 questionnaire revealed three groups of patients. 1. normal (9 patients). 2. slight impairment (115 patients) 3. moderate impairment (34 patients). Most of these patients had stable conditions except the sub group with deteriorating osteoarthritis of the hip/knee. Group 1 patients were all referred back to their GP. Thirty percent of group 2 patients were referred back to their GP, 60% were booked for a review and 10% were booked for surgery. None of Group 3 patients were referred back to their GP. Seventy percent required a clinical review and 30% were booked for surgery. Our clinical review is continuing but it is anticipated that those who still require surgery and score above the financial threshold will probably be less than one third of the cases.
Conclusion: This paper describes a decision making rationale in relation to assessment of continuing need for surgery in patients on the residual orthopaedic waiting list. Eighty percent of patients had stable conditions, which were not interfering significantly with their activities of daily living and could be managed safely by the GP. Further work is required to identify those patients who are at risk of deteriorating and to work out a practical and cost effective monitoring programme.
The abstracts were prepared by Professor Alan Thurston. Correspondence should be addressed to him at the New Zealand Orthopaedic Association, PO Box 7451, Wellington, New Zealand.
