Mayne Alistair I W, Cassidy Roslyn S, Magill Paul, Mockford B J, Acton Danny A, McAlinden M Gavan
Primary Joint Unit, Musgrave Park Hospital, Belfast, UK.
Bone Jt Open. 2022 Apr;3(4):302-306. doi: 10.1302/2633-1462.34.BJO-2022-0005.R1.
Waiting times for arthroplasty surgery in Northern Ireland are among the longest in the NHS, which have been further lengthened by the onset of the COVID-19 global pandemic in March 2020. The Department of Health in Northern Ireland has announced a new Elective Care Framework (ECF), with the framework proposing that by March 2026 no patient will wait more than 52 weeks for inpatient/day case treatment. We aimed to assess the feasibility of achieving this with reference to total hip arthroplasty (THA) and total knee arthroplasty (TKA).
Mathematical modelling was undertaken to calculate when the ECF targets will be achieved for THA and TKA, as well as the time when waiting lists for THA and TKA will be cleared. The number of patients currently on the waiting list and percentage operating capacity relative to pre-COVID-19 capacity was used to determine future projections.
As of May 2021, there were 3,757 patients awaiting primary THA and 4,469 patients awaiting primary TKA in Northern Ireland. Prior to April 2020, there were a mean 2,346 (2,085 to 2,610) patients per annum boarded for primary THA, a mean 2,514 (2,494 to 2,514) patients per annum boarded for primary TKA, and there were a mean 1,554 primary THAs and 1,518 primary TKAs performed per annum. The ECF targets for THA will only be achieved in 2030 if operating capacity is 200% of pre COVID-19 pandemic capacity and in 2042 if capacity is 170%. For TKA, the targets will be met in 2034 if capacity is 200% of pre-COVID-19 pandemic capacity.
This modelling demonstrates that, in the absence of major funding and reorganization of elective orthopaedic care, the targets set out in the ECF will not be achieved with regard to THA and TKA. Waiting times for THA and TKA surgery in Northern Ireland are likely to remain greater than 52 weeks for most of this decade. Cite this article: 2022;3(4):302-306.
北爱尔兰关节置换手术的等待时间在英国国民医疗服务体系（NHS）中是最长的，2020年3月新冠疫情爆发后等待时间进一步延长。北爱尔兰卫生部宣布了一项新的择期护理框架（ECF），该框架提议到2026年3月，住院/日间手术治疗的患者等待时间不超过52周。我们旨在参照全髋关节置换术（THA）和全膝关节置换术（TKA）评估实现这一目标的可行性。
进行数学建模以计算THA和TKA何时能实现ECF目标，以及THA和TKA的等候名单何时能清空。利用目前等候名单上的患者数量以及相对于新冠疫情前手术能力的手术容量百分比来确定未来预测。
截至2021年5月，北爱尔兰有3757名患者等待初次THA，4469名患者等待初次TKA。在2020年4月之前，每年平均有2346名（2085至2610名）患者登记接受初次THA，每年平均有2514名（2494至2514名）患者登记接受初次TKA，每年平均进行1554例初次THA和1518例初次TKA。如果手术能力是新冠疫情前手术能力的200%，THA的ECF目标将在2030年实现；如果手术能力是170%，则在2042年实现。对于TKA，如果手术能力是新冠疫情前手术能力的200%，目标将在2034年实现。
该模型表明，在缺乏重大资金投入和择期骨科护理重组的情况下，就THA和TKA而言，ECF设定的目标无法实现。在本十年的大部分时间里，北爱尔兰THA和TKA手术的等待时间可能会超过52周。引用本文：2022；3(4)：302 - 306。
