Primary hip and knee replacement surgery: Ontario criteria for case selection and surgical priority.

C D Naylor and J I Williams

Departments of Medicine and Surgery, University of Toronto, Ontario, Canada.

OBJECTIVES--To develop, from simple clinical factors, criteria to identify appropriate patients for referral to a surgeon for consideration for arthroplasty, and to rank them in the queue once surgery is agreed. DESIGN--Delphi process, with a panel including orthopaedic surgeons, rheumatologists, general practitioners, epidemiologists, and physiotherapists, who rated 120 case scenarios for appropriateness and 42 for waiting list priority. Scenarios incorporated combinations of relevant clinical factors. It was assumed that queues should be organised not simply by chronology but by clinical and social impact of delayed surgery. The panel focused on information obtained from clinical histories, to ensure the utility of the guidelines in practice. Relevant high quality research evidence was limited. SETTING--Ontario, Canada. MAIN MEASURES--Appropriateness ratings on a 7-point scale, and urgency rankings on a 4-point scale keyed to specific waiting times. RESULTS--Despite incomplete evidence panellists agreed on ratings in 92.5% of appropriateness and 73.8% of urgency scenarios versus 15% and 18% agreement expected by chance, respectively. Statistically validated algorithms in decision tree form, which should permit rapid estimation of urgency or appropriateness in practice, were compiled by recursive partitioning. Rating patterns and algorithms were also used to make brief written guidelines on how clinical factors affect appropriateness and urgency of surgery. A summary score was provided for each case scenario; scenarios could then be matched to chart audit results, with scoring for quality management. CONCLUSIONS--These algorithms and criteria can be used by managers or practitioners to assess appropriateness of referral for hip or knee replacement and relative rankings of patients in the queue for surgery.

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

This article has been cited by other articles:

• Dieppe, P., Dixon, D., Horwood, J., Pollard, B., Johnston, M., on behalf of the MOBILE research team, (2008). MOBILE and the provision of total joint replacement. J Health Serv Res Policy 13: 47-56 [Abstract] [Full Text]  
• Hamel, M. B., Toth, M., Legedza, A., Rosen, M. P. (2008). Joint Replacement Surgery in Elderly Patients With Severe Osteoarthritis of the Hip or Knee: Decision Making, Postoperative Recovery, and Clinical Outcomes. Arch Intern Med 168: 1430-1440 [Abstract] [Full Text]  
• Sampietro-Colom, L., Espallargues, M., Rodriguez, E., Comas, M., Alonso, J., Castells, X., Pinto, J.L. (2008). Wide Social Participation in Prioritizing Patients on Waiting Lists for Joint Replacement: A Conjoint Analysis. Med Decis Making 28: 554-566 [Abstract]  
• Dreinhofer, K E, Dieppe, P, Sturmer, T, Grober-Gratz, D, Floren, M, Gunther, K-P, Puhl, W, Brenner, H (2006). Indications for total hip replacement: comparison of assessments of orthopaedic surgeons and referring physicians. Ann Rheum Dis 65: 1346-1350 [Abstract] [Full Text]  
• Quintana, J. M., Escobar, A., Azkarate, J., Goenaga, J. I., Bilbao, A. (2005). Appropriateness of total hip joint replacement. Int J Qual Health Care 17: 315-321 [Abstract] [Full Text]  
• Graham, R. (2004). Cognitive Citizenship: Access to Hip Surgery for People with Dementia. Health (London) 8: 295-310 [Abstract]  
• Glozier, N., Groom, G., Prince, M. (2004). Patient Psychological Characteristics Have Minimal Influence on Surgical Prioritization. Psychosom. Med. 66: 251-257 [Abstract] [Full Text]  
• Holland, R., Harvey, I. (2003). Population needs assessment and knee replacement surgery. Rheumatology (Oxford) 42: 503-506 [Full Text]  
• Juni, P., Dieppe, P., Donovan, J., Peters, T., Eachus, J., Pearson, N., Greenwood, R., Frankel, S. (2003). Population requirement for primary knee replacement surgery: a cross-sectional study. Rheumatology (Oxford) 42: 516-521 [Abstract] [Full Text]  
• Woolhead, G. M., Donovan, J. L., Chard, J. A., Dieppe, P. A. (2002). Who should have priority for a knee joint replacement?. Rheumatology (Oxford) 41: 390-394 [Abstract] [Full Text]  
• Quintana, J. M., Arostegui, I., Azkarate, J., Goenaga, J. I., Guisasola, I., Alfageme, A., Diego, A. (2000). Evaluation by explicit criteria of the use of total hip joint replacement. Rheumatology (Oxford) 39: 1234-1241 [Abstract] [Full Text]  
• Lewis, S., Barer, M. L., Sanmartin, C., Sheps, S., Shortt, S. E.D., McDonald, P. W. (2000). Ending waiting-list mismanagement: principles and practice. CMAJ 162: 1297-1300 [Full Text]  
• Chocholik, J. K., Bouchard, S. E., Tan, J. K. H., Ostrow, D. N. (1999). The Determination of Relevant Goals and Criteria Used to Select an Automated Patient Care Information System: A Delphi Approach. J. Am. Med. Inform. Assoc. 6: 219-233 [Abstract] [Full Text]