Unmet Needs and Waiting List Prioritization for Knee Arthroplasty

• Published in: Clinical orthopaedics and related research 2010-03, Vol.468 (3), p.789-797
• Main Authors: Comas, Mercè, Román, Rubén, Quintana, José Maria, Castells, Xavier
• Format: Article
• Language: English
• Subjects: Arthroplasty, Replacement, Knee - statistics & numerical data; Biological and medical sciences; Catchment Area (Health) - statistics & numerical data; Clinical Research; Computer Simulation; Conservative Orthopedics; Diseases of the osteoarticular system; Female; Health Priorities - statistics & numerical data; Health Services Needs and Demand - statistics & numerical data; Humans; Male; Medical sciences; Medicine; Medicine & Public Health; Middle Aged; Models, Organizational; Orthopedic surgery; Orthopedics; Patient Selection; Spain; Sports Medicine; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgical Orthopedics; Waiting Lists
• ISSN: 0009-921X; 1528-1132
• DOI: 10.1007/s11999-009-1163-5

Background There is a high volume of unmet needs for knee arthroplasty in the population despite the increase in surgery rates. Given the long waiting times to have a knee arthroplasty, some governments have proposed prioritization systems for patients on waiting lists based on their level of need. Questions/Purposes We therefore estimated the needs and demand of knee arthroplasty in four regions of Spain during a 5-year period. Methods We developed a discrete event simulation model to reproduce the process of knee arthroplasty. The prioritization system was compared with the usual waiting list management strategy (by waiting time only). Results Under the prioritization system, patients saved an average of 4.5 months (95% confidence interval, 4.4–4.6 months) adjusted by level of need. The proportion of patients who experienced excessive waiting times was small and was associated with low levels of priority. The 5-year projection of the volume of unmet needs for knee arthroplasty remained stable; however, although the volume of need for the first knee arthroplasty decreased by 12%, the volume of need for an arthroplasty in the contralateral knee increased by 50%. Conclusions The data suggested the prioritization system was more beneficial than assigning surgery by waiting time only. The 5-year projection of the volume of unmet needs for knee arthroplasty remained stable, despite the increase in the need for contralateral knee arthroplasty. Level of Evidence Level II, economic and decision analyses. See Guidelines for Authors for a complete description of levels of evidence.