Background. The popular media infer that satisfaction with waiting lists for total hip or knee replacement surgery is poor; however, there is little supporting evidence for this. The purpose of this study was to describe patients satisfaction with the service they received for joint replacement surgery in a public hospital. Methods. A cross-sectional design was used to survey 450 patients. Data was analysed descriptively and chi-squared analyses (significance level of ) were used to examine associations between variables. Results. The response rate was 71%. Nearly three-quarters ( ) of the sample were “very happy” with the service and 92.0% ( ) indicated that they would have their surgery again. Satisfaction was significantly associated with waiting time to the first appointment (chi-square; ), whether the patients enquired about their waiting time (chisquare; ), and the number of preoperative appointments (chisquare; ). Most participants reported a maximum acceptable waiting period for initial appointment of less than 6 months but nearly half waited longer. Conclusions. The perception that patients are unhappy with elective surgery services in Australia may be unfounded despite many waiting longer than they consider appropriate. 1. Introduction There is emotive discussion in the popular press and the health literature surrounding the provision of elective surgery in publicly funded health systems in western countries [1, 2]. This is particularly related to the length of waiting lists, despite the current evidence regarding the clinical impact of long waiting lists being ambiguous—some studies suggest that patients deteriorate over time [3–6], while others report no change in clinical status. In Australia and elsewhere, total hip (THR) and total knee replacement (TKR) surgery are commonly used procedures in the treatment of end-stage osteoarthritis [7, 8]. Because of their commonality, they receive considerable attention and their waiting lists are easily compared to the national standards and are therefore convenient measures of how successfully the government or health service is delivering health care. Whether or not this is a fair assessment, the focus on waiting lists has encouraged governments and hospitals to introduce processes to monitor and manage waiting lists for publicly funded health services. For example, in 1996, New Zealand trialled “financially sustainable thresholds” for elective surgery, where health services could determine the number of elective surgeries performed based on their ability to fund them [9, 10]. In 2004, Australia
References
[1]
N. Hunter, “Shock 40% increase in waiting times,” Irish Independent, 2011.
[2]
A. Styles, “$2m less on hospital spending after elective surgery target missed,” Sydney Morning Herald, 2011.
[3]
F. Desmeules, C. E. Dionne, é. Belzile, R. Bourbonnais, and P. Frémont, “The burden of wait for knee replacement surgery: effects on pain, function and health-related quality of life at the time of surgery,” Rheumatology, vol. 49, no. 5, pp. 945–954, 2010.
[4]
J. M. Fielden, J. M. Cumming, J. G. Horne, P. A. Devane, A. Slack, and L. M. Gallagher, “Waiting for hip arthroplasty: economic costs and health outcomes,” Journal of Arthroplasty, vol. 20, no. 8, pp. 990–997, 2005.
[5]
D. S. Garbuz, M. Xu, C. P. Duncan, B. A. Masri, and B. Sobolev, “Delays worsen quality of life outcome of primary total hip arthroplasty,” Clinical Orthopaedics and Related Research, no. 447, pp. 79–84, 2006.
[6]
T. J. Hoogeboom, C. H. M. van den Ende, G. van der Sluis et al., “The impact of waiting for total joint replacement on pain and functional status: a systematic review,” Osteoarthritis and Cartilage, vol. 17, no. 11, pp. 1420–1427, 2009.
[7]
American Academy of Orthopaedic Surgeons, “Osteoarthritis of the hip: a compendium of evidence-based information and resources,” 1:1-G-5, 2003.
[8]
American Academy of Orthopaedic Surgeons, “Osteoarthritis of the knee: a compendium of evidence-based information and resources,” 1:1-4-18, 2002.
[9]
K. Dew, J. Cumming, D. McLeod et al., “Explicit rationing of elective services: implementing the New Zealand reforms,” Health Policy, vol. 74, no. 1, pp. 1–12, 2005.
[10]
A. D. MacCormick and B. R. Parry, “Waiting time thresholds: are they appropriate?” ANZ Journal of Surgery, vol. 73, no. 11, pp. 926–928, 2003.
[11]
Australian Government Department of Health and Ageing, “The state of our public hospitals,” Tech. Rep. 1:i-84, 2008.
[12]
R. Kingston, M. Carey, and E. Masterson, “Needs-based waiting lists for hip and knee arthroplasty,” Irish Journal of Medical Science, vol. 169, no. 2, pp. 125–126, 2000.
[13]
A. Lack, R. T. Edwards, and A. Boland, “Weights for waits: lessons from Salisbury,” Journal of Health Services Research and Policy, vol. 5, no. 2, pp. 83–88, 2000.
[14]
C. D. Naylor and J. I. Williams, “Primary hip and knee replacement surgery: Ontario criteria for case selection and surgical priority,” Quality and Safety in Health Care, vol. 5, no. 1, pp. 20–30, 1996.
[15]
B. Conner-Spady, G. Johnston, C. Sanmartin, J. J. McGurran, and T. W. Noseworthy, “Patient and surgeon views on maximum acceptable waiting times for joint replacement,” Healthcare Policy, vol. 3, no. 2, pp. 102–116, 2007.
[16]
B. Conner-Spady, A. Estey, G. Arnett et al., “Determinants of patient and surgeon perspectives on maximum acceptable waiting times for hip and knee arthroplasty,” Journal of Health Services Research and Policy, vol. 10, no. 2, pp. 84–90, 2005.
[17]
Australian Government Department of Health and Ageing, “The state of our public hospitals,” Tech. Rep. 1:i-102, 2009.
[18]
T. Smith, “Waiting times: monitoring the total postreferral wait,” British Medical Journal, vol. 309, no. 6954, pp. 593–596, 1994.
[19]
South Australian Department of Health, Policy Framework and Associated Guidelines for Elective Surgery Services, vol. 1, 2006.
[20]
L. G. Portney and M. P. Watkins, Foundations of Clinical Research: Applications to Practice, Prentice-Hall, NJ, USA, 2nd edition, 2000.
[21]
J. Glover, D. Hetzel, L. Glover, A. Page, and K. Leahy, Central Northern Adelaide Health Service: A Social Health Atlas, 2005.
[22]
V. Braun and V. Clarke, “Using thematic analysis in psychology,” Qualitative Research in Psychology, vol. 3, no. 2, pp. 77–101, 2006.
[23]
S. Ryan, “Longer waits for surgery put pressure on PM,” The Australian, 2009.
[24]
B. L. Conner-Spady, C. Sanmartin, G. H. Johnston, J. J. McGurran, M. Kehler, and T. W. Noseworthy, “The importance of patient expectations as a determinant of satisfaction with waiting times for hip and knee replacement surgery,” Health Policy, vol. 101, no. 3, pp. 245–252, 2011.
[25]
D. A. Cromwell and D. A. Griffiths, “Waiting time information services: how well do different statistics forecast a patient's wait?” Australian Health Review, vol. 25, no. 6, pp. 75–85, 2002.
[26]
D. Cromwell and D. Griffiths, “Waiting time information services: what are the implications of waiting list behaviour for their design?” Australian Health Review, vol. 25, no. 4, pp. 40–49, 2002.
[27]
B. L. Conner-Spady, G. H. Johnston, C. Sanmartin et al., “A bird can't fly on one wing: patient views on waiting for hip and knee replacement surgery,” Health Expectations, vol. 10, no. 2, pp. 108–116, 2007.
[28]
B. Conner-Spady, C. Sanmartin, G. Johnston, J. McGurran, M. Kehler, and T. Noseworthy, “'There are too many of us to fix.' Patients' views of acceptable waiting times for hip and knee replacement,” Journal of Health Services Research and Policy, vol. 14, no. 4, pp. 212–218, 2009.
[29]
R. T. Edwards, A. Boland, C. Wilkinson, D. Cohen, and J. Williams, “Clinical and lay preferences for the explicit prioritisation of elective waiting lists: survey evidence from Wales,” Health Policy, vol. 63, no. 3, pp. 229–237, 2003.
[30]
G. M. Woolhead, J. L. Donovan, J. A. Chard, and P. A. Dieppe, “Who should have priority for a knee joint replacement?” Rheumatology, vol. 41, no. 4, pp. 390–394, 2002.
