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.