Backgrounder for Wait times for joint replacement surgery

[ Press Release 2005-50 ]

This summary was developed by CIHR and is based on two separate research syntheses. Please visit the below links for a copy of the complete reports:

• Dr. Thomas Noseworthy (University of Calgary) and team
• Dr. Bas Masri and Dr. Clive Duncan (University of British Columbia) and team

Background

In February 2005, Canada's Provincial and Territorial Ministries of Health, in partnership with CIHR's Institutes of Health Services and Policy Research, Cancer Research, and Musculoskeletal Health and Arthritis, agreed to fund research designed to inform the establishment of evidence-based benchmarks for medically acceptable wait times in select clinical areas.

Eight Canadian research teams, based in British Columbia, Alberta, Manitoba, Saskatchewan, Quebec, Nova Scotia, and Ontario, carried out research regarding wait times for three priority treatment areas: sight restoration, joint replacement, and cancer. While similar research in the areas of cardiac care and diagnostic imaging was also solicited in February, no projects focused on those areas were funded at that time.

This research was designed to inform the work of the Provincial and Territorial Ministers of Health in establishing evidence-based benchmarks for wait times for joint replacement surgery in Canada. Two main questions were asked:

1. What does existing research say about the relationship between clinical condition, wait times, and health outcomes or quality of life for individuals waiting for joint replacement surgery?
2. What are the national or international wait time benchmarks (proposed or in use) for these procedures, and what research evidence (if any) are they based on?

The researchers examined evidence from the available research studies regarding hip and knee replacements, two of the most common joint replacement procedures. They focused on the relationship between wait times and the health of individuals while waiting for joint replacement surgery, or after surgery. The researchers also reviewed national and international benchmarks for wait times for joint replacement surgery. Most of the research reviewed focused on the wait between the date an individual is placed on a waiting list by a specialist and the date of their surgery.

What the research says about the effect on health of waiting for hip and knee replacement surgery

• Individuals waiting more than 6 months for surgery may experience a decline in health.

• Wait times of more than 12 months may result in poorer outcomes after surgery.
• Individuals with poorer health before surgery experience poorer outcomes after surgery.

• Individuals may be able to wait longer or shorter periods depending on their overall health at the point in time when surgery is recommended.

National or international benchmarks

• The majority of international wait time benchmarks apply to surgical procedures generally, rather than specifically to joint replacement surgery. These benchmarks range from 3-12 months from assessment by a specialist to surgery. Countries with established wait time benchmarks include the United Kingdom, New Zealand, Australia, Spain, Italy, Sweden, The Netherlands, Ireland, and Finland.

• There is some consistency across countries for a benchmark wait time for hip and knee replacements of not more than 6 months from assessment by a specialist to surgery.

• In Canada, some organizations and provinces have already proposed wait time benchmarks specifically for joint replacements. All proposed benchmarks are associated with a management system that prioritizes an individual's wait according to clinical need. Several have a maximum wait time of 5 to 6 months from assessment by a specialist to surgery.

• International benchmarks have been developed mainly through input from clinicians and learnings from other jurisdictions. In Canada, proposed benchmarks, while still based primarily on clinical opinion, have paid more attention to literature reviews and international experience.

Take-home messages

• The available scientific evidence regarding the relationships between health and wait times suggests a benchmark wait time of not more than 6 months for hip or knee replacement surgery. This benchmark reflects a maximum reasonable wait. Individuals may be able to wait longer or shorter periods depending on their overall health at the point in time when surgery is recommended.

• It is important to establish management strategies alongside benchmarks to ensure that individuals awaiting hip or knee replacement surgery are placed on lists at the appropriate time, and that those on waiting lists are ranked so that receipt of surgery is roughly in line with relative need for surgery.