What effect have commissioners’ policies for body mass index had on hip replacement surgery?: an interrupted time series analysis from the National Joint Registry for England

BMC Medicine

Research Article

J. Mark Wilkinson¹  Samuel Hawley²  Joanna McLaughlin²  Andrew Judge³  Ruth Kipping⁴  Amanda Owen-Smith⁴  Hugh McLeod⁵ 

[1] Department of Oncology and Metabolism, The Mellanby Centre for Musculoskeletal Research, University of Sheffield, Metabolic Bone Unit, Sorby Wing, Northern General Hospital, Sheffield, UK;Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Learning and Research Building, Level 1, Southmead Hospital, BS10 5NB, Bristol, UK;Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Learning and Research Building, Level 1, Southmead Hospital, BS10 5NB, Bristol, UK;National Institute for Health and Care Research Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and University of Bristol, Bristol, UK;Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK;Population Health Sciences, Bristol Medical School, University of Bristol, BS8 2PS, Bristol, UK;Population Health Sciences, Bristol Medical School, University of Bristol, BS8 2PS, Bristol, UK;National Institute for Health and Care Research Applied Research Collaboration West (NIHR ARC West), University Hospitals Bristol NHS Foundation Trust, BS1 2NT, Bristol, UK;

关键词: Hip replacement;    Obesity;    Epidemiology;    Osteoarthritis;    Commissioning;    Health policy;   

DOI  :  10.1186/s12916-023-02899-3

 received in 2023-04-24, accepted in 2023-05-10,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundDespite their widespread use, the impact of commissioners’ policies for body mass index (BMI) for access to elective surgery is not clear. Policy use varies by locality, and there are concerns that these policies may worsen health inequalities. The aim of this study was to assess the impact of policies for BMI on access to hip replacement surgery in England.MethodsA natural experimental study using interrupted time series and difference-in-differences analysis. We used National Joint Registry data for 480,364 patients who had primary hip replacement surgery in England between January 2009 and December 2019. Clinical commissioning group policies introduced before June 2018 to alter access to hip replacement for patients with overweight or obesity were considered the intervention. The main outcome measures were rate of surgery and patient demographics (BMI, index of multiple deprivation, independently funded surgery) over time.ResultsCommissioning localities which introduced a policy had higher surgery rates at baseline than those which did not. Rates of surgery fell after policy introduction, whereas rates rose in localities with no policy. ‘Strict’ policies mandating a BMI threshold for access to surgery were associated with the sharpest fall in rates (trend change of − 1.39 operations per 100,000 population aged 40 + per quarter-year, 95% confidence interval − 1.81 to − 0.97, P < 0.001). Localities with BMI policies have higher proportions of independently funded surgery and more affluent patients receiving surgery, indicating increasing health inequalities. Policies enforcing extra waiting time before surgery were associated with worsening mean pre-operative symptom scores and rising obesity.ConclusionsCommissioners and policymakers should be aware of the counterproductive effects of BMI policies on patient outcomes and inequalities. We recommend that BMI policies involving extra waiting time or mandatory BMI thresholds are no longer used to reduce access to hip replacement surgery.

【 授权许可】

CC BY   
© The Author(s) 2023

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