Costs of falling off surgery list

By MARTIN JOHNSTON health reporter

Some people needing hip and knee replacements but dumped from surgery waiting lists are being forced into resthomes, are suffering depression and are unable to leave their homes.

These are some of the findings of a study at Taranaki Base Hospital. The authors say the findings reflect the national situation in elective orthopaedic surgery.

The study by surgeon Tim Lynskey and trainee Dr David Ardern assessed 71 patients nine months after they were removed from the waiting list without a clinical review.

They were insufficiently disabled to qualify for treatment within the benchmark six months under the Government's points-based surgery booking system.

Others removed from the list but later received surgery numbered 27, of whom 11 chose the private sector. A further 13 no longer needed surgery.

The Orthopaedics Association says the cost of orthopaedic surgery is often less than having patients on a waiting list, or worse still dropping them off it.

The researchers found that removal from the list was linked to 12 patients having difficulty with work and to three being on a benefit. Two were unable to work but not receiving a benefit.

Almost all needed more regular visits to their GP and most said they had lost some independence.

Significant stomach problems from arthritis medication afflicted 19 and two were admitted to hospital with gastro-intestinal bleeding.

Two fell and were injured.

Most were in constant pain, ranging from moderate to severe, and most also needed at least one walking stick.

More than half were unable to walk five blocks non-stop and several were so disabled they could not leave their homes.

"One man is in a resthome as a result of not having surgery," said Dr Ardern. "There's a reasonable chance he wouldn't be there if he had surgery."

Others in the study were also housebound or in a resthome, but not because of their need for a joint replacement.

Dr Ardern said not all 71 in the study would benefit from surgery, "but the majority would be vastly helped by surgery".

Mr Lynskey, who will present the results to an orthopaedic surgery conference in Rotorua today, said that he had seen patients' caregivers suffer when patients were removed from the list. "It's just chaos ... That's why we did the study."

But Health Minister Annette King said last night that orthopaedics funding had not been cut. It was largely up to each district health board to decide its own priorities in divvying up its elective surgery cash.

The ministry was checking for spare orthopaedic surgery capacity.

Trauma of waiting

Study of 71 patients removed from hip and knee replacement waiting list.

Patients' average age: 70.

Nearly half reported depression and six required treatment for it.

One became suicidal.

Two admitted to hospital for bleeding caused by arthritis drugs.

Cost of hip replacement: $9500 to $11,500.