Total joint replacement: implication of cancelled operations for hospital costs and waiting list management.

OBJECTIVE To identify aspects of provision of total joint replacements which could be improved. DESIGN 10 month prospective study of hospital admissions and hospital costs for patients whose total joint replacement was cancelled. SETTING Information and Waiting List Unit, Musgrave Park Regional Orthopaedic Service, Belfast. PATIENTS 284 consecutive patients called for admission for total joint replacement. MAIN MEASURES Costs of cancellation of operation after admission in terms of hotel and opportunity costs. RESULTS 28(10%) planned operations were cancelled, 27 of which were avoidable cancellations. Five replacement patients were substituted on the theatre list, leaving 22(8%) of 232 operating theatre opportunities unused. Patients seen at assessment clinics within two months before admission had a significantly higher operation rate than those admitted from a routine waiting list (224/232(97%) v 32/52(62%), x2 = 58.6, df = 1; p < 0.005). Mean duration of hospital stay in 28 patients with cancelled operations was 1.92 days. Operating theatre opportunity costs were 73% of the total costs of cancelled total joint replacements. CONCLUSION Patients on long waiting lists for surgery should be reassessed before admission to avoid wasting theatre opportunities, whose cost is the largest component of the total costs of cancelled operations.