Has the state of NHS waiting lists changed the landscape for same day knee replacements? Nick London explains why, for the time being at least, the answer should remain ‘no’.
We are not the only country facing growing waiting lists for elective (that is, non-emergency) procedures. The last time the OECD carried out its global waiting times study, Australians, Poles, Estonians, Canadians and more all had longer waits than in the UK. Chile has the longest waiting lists in the world.
As those waiting lists have grown still further post-pandemic, some countries have made the decision to cut the lists by cutting the time spent in hospital for knee replacement surgery. As this local report from Canada shows, health authorities are choosing to cut surgical wait lists by focusing on same day hip and knee replacements.
Is same day the right target?
We talked about this back in 2020 at the height of the pandemic. Despite the growing pressure on health providers, the situation remains much as it was. Globally, we’re seeing an acceleration in the shift towards same day knee surgery. In the UK, while we could switch to a same day system in many instances, it would be far from ideal unless we were able to change the nature of patient support to reflect that new system.
If a hospital or health trust were able to safely support patients in their own home, with the wound care, pain management and rehabilitation that patients need, then we would likely support an increasing number of patients going down a same day pathway. But for the majority of patients currently in the UK—and for the majority of hospitals— we simply don’t have the safety checks and the level of community support in place. That makes same day the riskier, less optimal approach.
Yorkshire Knee Clinic’s surgeons fully support early, safe discharge of patients, but for knee replacements that is normally the day after (and almost always within a couple of days of) surgery, when we’ve had the opportunity to ensure a patient’s pain is under control, when we are comfortable with the patient’s wound, and when the correct rehabilitation process is in place.
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