Abstract
Introduction
Elective Orthopaedics has been targeted by the UK Department of Health as a maximum six-month waiting time for operations could not be met. The National Orthopaedic Project was initiated as a consequence and Independent Sector Treatment Centres (ISTCs) and well established private hospitals were utilised to treat NHS long wait patients.
Materials and methods
We audited the primary total hip replacements performed in our hospital in 1998 and 2003 to compare the differences in the patient characteristics in particular age, length of stay and ASA grade.
Results
The number of hip replacements increased to 308 in year 2003 from 194 in year 1998. Whilst the number of ASA I patients was the same, the ASA II, III and IV increased by 40%, 260% and 266% respectively. The average length of stay decreased from 14.3 to 11.9 days which was statistically significant, in spite of increased numbers of ASA II - IV patients.
Discussion
The NHS hospitals are treating an increasing number of patients who have a higher anaesthetic risk and stay longer in the hospital in the post-operative period. The case mix for primary total hip replacements in large tertiary referral hospitals has changed due to altered patient flow due to cherry picking of NHS waiting lists by the ISTCs. NHS hospitals should be appropriately remunerated for dealing with complex cases. On average based on our data, ASA III patients stay 3 days longer than ASA I (ASA IV - 5 days). The extra cost incurred is £221 (£433) / day x 3 extra days = £ 663 (£ 1329) / case. According to the 2nd annual NJR report, 4,617 ASA III patients were operated in NHS hospitals and the extra cost incurred towards their length of stay would be £3.06 million (£6.1 million).
