Knee replacements stagnate in parts of England with weight rules for patients | Health

The number of knee replacement operations performed has fallen in areas of England with restrictions on surgery for overweight patients, with people in the most disadvantaged areas most affectedfound researchers.

Patients requiring surgery but unable to lose weight are being denied surgery that could relieve pain and increase mobility, the team University of Bristol said.

Health campaigners have expressed concern, saying the policy is a “blunt tool” used to replace conversations between doctors and patients and risks exacerbating health inequalities.

Over the last decade rules have been introduced by some Clinical Commissioning Groups (CCGs) across England to restrict access to hip and knee replacement surgery for overweight or obese patients.

There are significant regional differences, with stricter BCCs telling patients they must reach a certain body mass index (BMI) before surgery can take place or imposing a wait time. Others impose no restrictions.

The study, funded by the National Institute for Health and Care Researchsuggests that regions that introduced policy changes for access to knee replacement surgery based on patient weight or BMI experienced a decline in surgery.

Researchers analyzed the knee replacement surgery rates of 481,555 patients between January 2009 and December 2019 – before the Covid pandemic hit – using data from the National joint register and regions compared with and without BMI/weight policy.

The study found that more than two-thirds of CCGs in England had a BMI policy for knee replacement surgery, with 61% of these policies denying access to surgery or imposing additional wait time. He said surgery overall was down 14% compared to what would have been expected if no policies restricting access had been introduced.

By looking at patients’ postcodes, the researchers could see that people from more deprived areas seemed more likely to be denied surgery.

The main author, Joanna McLaughlin, from Bristol Medical School, said: “Our study raises concern that these policies are linked to worsening health inequalities with fewer NHS operations for less affluent groups. We could see surgery rates going down for the worst off, but going up for the better off, which correlates with the increase in private surgery in those areas.

She said it was not helpful to pick the numbers for particular GCCs because local factors could skew the data. But it is clear that different approaches are taken in neighboring areas. South Lincolnshire, for example, has more liberal rules while just across the border in North Norfolk they are stricter.

The report states that with one in 10 people likely to need knee replacement surgery, several thousand patients are affected.

Jacob Lant, Head of Policy, Partnerships and Research at Healthwatch Englandsaid: “Roughly using BMI in this way is not helpful and should be treated as a guideline rather than a hard and fast rule. What is really needed is a conversation between physicians and patients on the individual circumstances of the patient.Weight loss can be incredibly difficult, especially for those whose mobility is already affected by joint problems.

The study, What effect have NHS commissioners’ body mass index policies had on access to knee replacement surgery in England?, was published in the journal PLOS ONE.

Professor John Skinner, Board Member of the Royal College of Surgeons of England and Consultant Orthopedic Surgeon, said: “Hip and knee replacement surgery for osteoarthritis results in dramatic improvements in quality of life. The surgical decision must be made individually for each patient. Restrictive orientation policies, such as BMI thresholds, penalize patients who become more immobile and are therefore at risk of suffering other health problems. The Nice guidelines make it clear that restricting access to joint replacement based on BMI, smoking, or other characteristics should not occur.

“This research paper confirms that restricting access to surgery due to BMI has a significant effect on access to care and worsens inequalities. It is reasonable to encourage weight loss where appropriate and most hospitals operate a weight loss incentive system for patients with a BMI of 40. However, this research shows that if commissioners restrict the access to patients with a high BMI, then much greater variability and inequality occurs for patients.

A spokesman for the Department of Health and Social Care said: “We are helping local authorities improve public health by increasing their grant to just over £3.4billion this year, and we are investing £39billion additional pounds in health and care over the next three years. .”

NEW//An NHS spokesperson said: “Patients and clinicians work together before surgery to optimize the chances of getting the best outcome, and in some cases, losing weight before surgery reduces risk for patients and improves the chances of success for the procedure. “//ENDS

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