The burden of disease in patients awaiting joint replacement surgery - A study of 2091 patients

Abstract

Background: In Hong Kong, due to limitations in resources in the public sector, patients indicated for joint replacement are placed on a waiting list and may need to wait for years for their procedure. The effect of this delay in joint replacement on a patient’s overall morbidity and mortality is currently unknown and no study has examined this previously. 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. Methods: All patients that were put on waiting list primary total hip, knee and unicompartmental knee replacements in our cluster from November 2009 till March 2020 were included for analysis. CDARS system was used for data retrieval. Incidence of all-cause hospital admissions, AED attendances and occurrence of major medical events was calculated. Results and Discussion: In total, 3715 patients had been placed on waiting list for primary joint replacement from 11/2009 till 3/2020. After exclusion of 965 cancellations, 2972 replacements in 2109 patients were included for analysis. 3.2% died while awaiting joint replacement. Incidence of all-cause hospitalisation and peptic ulcers were higher during the waiting period than at baseline and after operation. NSAID use was significantly related to increased hospitalisation and cardiovascular events during the waiting period. 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 awaiting joint replacement.