Patients who need surgery but cannot lose weight are lacking surgery that could relieve pain and increase mobility, the team at the University of Bristol said. Health activists have expressed concern that the policy was a “blunt tool” used to replace conversations between doctors and patients and risked exacerbating health inequalities. Over the last decade, some clinical assignment groups (CCGs) have established rules across the UK to restrict access to hip and knee replacement surgery for patients who are overweight or obese. There are significant peripheral differences, with stricter CCGs telling patients that they must achieve a certain body mass index (BMI) before surgery or impose a waiting time. Others do not impose restrictions. The study, funded by the National Institutes of Health and Care Research, suggests that areas that have introduced policy changes to access knee replacement surgery based on a patient’s weight or BMI have seen a reduction in surgery. The researchers analyzed knee replacement surgery rates in 481,555 patients between January 2009 and December 2019 – before the Covid pandemic struck – using data from the National Register and compared areas with and without a BMI / weight policy. The study found that more than two-thirds of CCGs in the UK had a BMI policy for knee replacement surgery, with 61% of these policies denying access to surgery or imposing extra waiting time. He said surgery was down a total of 14% from what would have been expected if policies had not been introduced to restrict access. Looking at patients’ zip codes, the researchers could see that people from more degraded areas seemed more likely to refuse surgery. Lead author Joanna McLaughlin of Bristol School of Medicine said: “Our study raises concerns that these policies are linked to worsening health inequalities with fewer NHS interventions for less affluent groups. “We could see rates of surgery decrease for those in the worst condition, but increase for those in the best condition, which is related to more private surgery in these areas.” He said it was not useful to select data for specific CCGs as local factors could distort the data. But it is clear that there are different approaches in neighboring areas. South Lincolnshire, for example, has more liberal rules, while the requirements are stricter next to North Norfolk. The report states that with one in 10 people likely to need a knee replacement, many thousands of patients are affected. Jacob Lant, Head of Policy, Partnership and Research at Healthwatch England, said: What really needs to happen is a discussion between doctors and patients about the specific circumstances of the patient. “Losing weight can be incredibly challenging, especially for those whose mobility has already been affected by joint problems.” The study – entitled How did the NHS Commissioners’ policies on body mass index affect access to knee replacement surgery in England? – published in PLOS ONE magazine. Professor John Skinner, a board member of the Royal College of Surgeons of England and a consultant orthopedic surgeon, said: “Hip and knee replacement surgery for osteoarthritis leads to a dramatic improvement in quality of life. Surgical decisions should be made on an individual basis for each patient. “Restrictive referral policies, such as BMI limits, punish patients who become more immobile and are then more likely to suffer further health problems. The Nice Guidelines clearly state that restricting access to joint replacement based on BMI, smoking or other characteristics should not occur. “This research confirms that restricting access to surgery due to BMI has a significant effect on access to care and exacerbates inequalities. “It makes sense to encourage weight loss where needed and most hospitals have a weight loss incentive system in patients with BMI 40. However, this research shows that if commissioners restrict access for patients with high BMI, then variability and there is much greater inequality for patients “. A spokesman for the Ministry of Health and Social Welfare said: “We are helping local authorities improve public health by increasing their grants to just over 4 3.4 billion £ this year and investing an additional 39 39 billion £ in overall health and care over the next three years. » An NHS spokesman said: “Patients and clinicians work together before surgery to optimize their chances of getting the best results, and in some cases losing weight before surgery reduces patients’ risk and improves their chances of success. of the procedure”.
