Table 8 Results of studies exploring surgical outcomes
From: Assessing demographic access to hip replacement surgery in the United Kingdom: a systematic review
Ref. | Study timeframe | Estimate of surgical need | Estimate of surgical outcome | Socio-demographic domains | Conclusions |
|---|---|---|---|---|---|
[37] | January 1998 to March 2005 | Harris Hip score to determine severity of hip condition and SF-36 to determine patient quality of life ASA score to determine surgical risk Reported patient comorbidities | Harris Hip Score SF-36 | - Age - Gender - Area-based deprivation (Scottish IMD 2006) - BMI - Smoking status - Comorbidities - Surgical complications - Mortality - ASA score of presurgical fitness - Quality of life (SF-36 mental and physical) | - 42.6 point improvement in HHS 18 months post-surgery (95% C.I: 41.8–43.4) - No overall change in mean SF-36 mental score 18 months post-surgery (95% C.I: 0.2–2.5) Deprivation - No difference in post-surgical HHS improvement between deprivation quintiles (p = 0.069) - The most deprived patients had HHS 3.85 points lower pre-surgery (95% C.I: 0.88–6.82), 5.03 points lower 6-months post-surgery (95% C.I: 1.92–8.14) and 4.55 points lower 18-months post-surgery (95% C.I: 0.74–8.35) than the least deprived patients - Significant difference in physical quality of life between least and most deprived patients: physical SF-36 score was 8.09 points higher (95% C.I: 1.45–14.73) - Mental-health quality of life only improved in the least deprived: mental SF-36 core was 4.7 points higher (95% C.I: 1.5–7.8) - No significant differences in length of stay (p = 0.936) - Significantly fewer smokers in the least deprived quintile compared to most deprived (p < 0.001) - No significant difference in BMI between quintiles Gender – no significant differences (p = 0.238) Comorbidity – no differences |
[28] | March 2004 to October 2005 | POSSUM score to determine physiological risk factors, condition severity and surgical risk ASA score to determine surgical risk Reported patient comorbidities | POMS survey to assess post-operative morbidity | - Age - Gender - Area-based deprivation (IMD 2004) - White ethnicity - ASA score - Surgery duration - Morbidity | Deprivation - Surgical risk decreased with decreasing deprivation quintile (Q5-Q1) (p = 0.04) - 2% increase in predicted surgical risk for most deprived quintile versus least deprived quintile - No evidence for relationship between SES and postoperative morbidity or infectious morbidity - No relationship found between post-surgical length of stay and patient SES - Less deprived patients more likely to be morbidity-free and have left hospital by day 8 post-surgery |
[39] | January 2006 to November 2008 | Charlson index of comorbidity to assess patient comorbidities Oxford hip score to determine severity of hip condition SF-12 score to determine patient quality of life | Custom patient satisfaction questionnaire Oxford hip score SF-12 score | - Age - Gender - Area-based deprivation (Carstairs index) - BMI - Primary diagnosis - Comorbidities - Surgical complications - 90-day mortality rate - Quality of life (SF-12 score) | Deprivation - No association was found between SES and prevalence of hip replacement (p = 0.36) - DEPCATs were significant predictors for mean post-surgical improvement, after adjusting for pre-surgical scores, comorbidity, age, SF-12 score and length of stay (p = 0.001) -Most deprived patients had mean pre-surgery OHS 5.8 points higher than least deprived patients (p = 0.001) - Most deprived patients with higher pre-surgery OHS had greater improvement in postoperative score than least deprived patients with lower pre-surgery OHS - Most deprived patients were more likely to suffer dislocation (p < 0.001) and had higher 90-day mortality risk (p = 0.02) Age/comorbidities - More deprived patients were younger at time of surgery (p = 0.04) and had more comorbidities (p = 0.02) - No association was found between mean Charlson index of comorbidities and SES however (p = 0.09) - No association was found between SES and BMI (p = 0.5) |
[33] | April 2009 to February 2011 | Oxford hip score to determine severity of hip condition Patients asked how long their hip problems been present and which comorbidities they have | Oxford hip score ‘Overall, how are the problems now in the (hip/knee) on which you had surgery, compared with before your operation?’ | - Age - Gender - Area-level deprivation (IMD 2007) - Non-white ethnicity - Primary diagnosis - Comorbidities - General Health - Hospital fixed effects | Deprivation - Most deprived patients had lower pre-surgery OHS than least deprived: most deprived = 15.7, least deprived =19.7 - Most deprived patients had lower post-surgery OHS than least deprived: most deprived = 34.4, least deprived = 39.4 - More deprived patients reported greater hip-related pain and disability 6 months post-surgery, in addition to poor circulation and depression - 8.2% of most deprived patients reported no improvement post-surgery versus 5.0% of least deprived patients Comorbidities - Patients in more deprived areas had more self-reported comorbidities (except cancer) and poorer overall health (33% poor health in most deprived versus 18% in least deprived) Age/Ethnicity - More deprived patients were more likely younger (below 60 years) and of non-white ethnicity - After adjusting for age, sex, poor pre-surgery health, comorbidities and ethnicity, the association between SES and post-surgery OHS was reduced |
[38] | 2001 to 2008 | Patient comorbidities extracted from HES data | Post-surgical length of stay in hospital from admission to discharge (including treatment for surgical complications) | - Age - Gender - Area-based deprivation (IMD 2004) - Number of diagnoses - Hospital activity | Deprivation - Least deprived patients stay 0.9 days less than the most deprived patients at the same hospital - Most deprived patients stay 6% longer than other patients in 2001-2002, but this fell to 2% longer by 2007-2008 Age - Patients over 85 years stayed 7.74 days longer than patients aged 45-54 - Larger differences between age groups dwarf deprivation gradient in length of stay for age Comorbidities - Patients with 7 or more comorbidities stay 7.18 days longer than patients with one diagnosis - Length of stay for patients with 7+ comorbidities rose from 58% longer in 2001-2002 to 73% by 2007-2008 Hospital effects - Positive hospital-level association – hospitals treated lower SES patients have longer lengths of stay (after adjusting for other patient characteristics) |