Thousands of NHS knee replacement operations are cancelled at short notice every year, many for avoidable reasons, according to a new study published this month. This costs the NHS millions of pounds and increases waiting times for patients, many of whom are in severe pain.
The study, led by researchers at the University of Bristol’s National Institute for Health and Care Research (NIHR) Bristol Biomedical Research Centre (Bristol BRC), and sponsored by North Bristol NHS Trust, is published in The Bone & Joint Journal.
The NIHR-funded study collected information on the timing of, and reasons for, cancellation of total knee replacement surgery at 6 NHS hospitals in England, Scotland, Wales and Northern Ireland, over a period of 5 years between April 2018 and March 2023.
The study found at the 6 hospitals over the 5 years 17,223 total knee replacement operations were completed and 9,403 cancelled – more than previously thought. This is the first study to measure total knee replacement cancellations across more than one hospital.
Each operation cancelled at short notice costs the NHS a lost tariff of between £6,500 and £11,000. This adds up to over £15.5 million across the 6 hospitals, over 5 years.
A quarter of the cancellations were less than 24 hours before surgery, and nearly one third were within 2 to14 days. Cancellations the day before, or on the same day as surgery, can leave empty operating theatre spaces which are difficult to fill. Rescheduling these operations adds to already lengthy NHS waiting lists.
Cancelled surgery and increased waiting times can reduce patients’ quality of life and leave them feeling rejected. Patients on the waiting list experience a significant decrease in quality of life after 6 to 12 months of waiting for total knee replacement surgery – a quarter say they are waiting in a state “worse than death”, according to previous studies.
Lack of available hospital beds and patients being unfit for surgery were the most common reasons for short-notice cancellations. Many of these cancellations could have been avoided with advance planning.
Heart problems, infections and wounds were the main health reasons for cancelling surgery. With the right medical care while people wait for their operation, many patients could be supported to be medically fit for surgery, and cancellations avoided.
The scale of this problem is huge. Knee replacements are one of the most common types of surgery, with over 110,000 total knee replacements performed yearly in the UK. More than 3 million people are currently waiting more than 18 weeks for non-urgent NHS surgery.
This highlights an urgent need for efficiency programmes in the NHS, and UK-wide healthcare planning for patients on waiting lists, to prevent cancellations.
Dr Mark Eveleigh, Consultant Anaesthetist at Gloucestershire Hospitals NHS Foundation Trust, said: “Cancelled operations aren’t just about wasted resources. Each cancellation statistic represents a patient who has often uprooted their entire life to get into hospital, followed the preparation advice to the letter, arranged transport and found someone to look after loved ones, frequently at great cost to themselves.
“So for us then not to do the operation after they have gone through all that is, in my mind, unforgivable.
“We should strive for zero avoidable cancellations, and projects like this are the first step to realising that across the NHS. Until we know what drives cancellations, we cannot realistically expect them to simply stop happening.”
Michael Whitehouse, Professor of Trauma and Orthopaedics at the University of Bristol, and a co-author on the paper, explained: “This work has demonstrated a substantial and underappreciated problem for the large number of patients waiting for joint replacement surgery.
“Pathways patients have to follow are often complicated and difficult