Authors (including presenting author) :
Cheung A (1), Fu H (1), Chan PK (1), Cheung MH (2), Chan VWK (1), Yan CH (2), Chiu KY (2)
Affiliation :
(1) Department of Orthopaedics and Traumatology, Queen Mary Hospital, (2) Department of Orthopaedics and Traumatology, University of Hong Kong
Introduction :
Serious joint conditions pose a major challenge to healthcare systems worldwide. Such conditions have been found to be related to increased risk of premature death, cardiovascular and cerebrovascular (CVS) events.
In many developed countries worldwide, patients with joint conditions warranting arthroplasty procedures may be able to receive such procedures expediently. In Hong Kong, due to limitations in resources in the public sector, patients that are indicated for arthroplasty procedures are placed on a waiting list and may need to wait for years before they can receive their joint replacement. The effect of this delay in joint replacement, the waiting period, on a patient’s overall morbidity and mortality is currently unknown as no study has examined this previously.
Objectives :
The aims of this study were to 1) quantify the degree of and 2) identify factors related to patient morbidity and mortality associated with joint replacement waiting list.
Methodology :
All patients that were put on waiting list primary total hip, knee and uni-compartmental knee replacements in our cluster from November 2009 till March 2020 were included for analysis. CDARS system was used for data retrieval at 3 different time intervals: 1 – during the 3 years prior to being on waiting list (baseline), 2 – while awaiting joint replacement surgery (waiting period) and 3 - during the period from 1 year till 3 years post-operation (post-operation period). Incidence of all-cause hospital admissions, AED attendances and occurrence of major medical events was calculated.
Result & Outcome :
3175 patients had been placed on waiting list for primary joint replacement from 11/2009 till 3/2020. After exclusion of cancellations, 2758 replacements in 2105 patients were included for analysis. 2.4% died while waiting list joint replacement. Incidence of all-cause hospitalisation and peptic ulcers were significantly higher during the waiting period than at baseline and post-operation (p< 0.001 for both).
NSAID use was significantly related to increased hospitalisation and cardiovascular events during the waiting period (p< 0.001).
In conclusion, Patients waiting for joint replacement are at an increased risk of hospitalisation and peptic ulcer events. NSAID usage is a major factor leading to patient morbidity while on waiting for joint replacement.
