Researchers have found that the number of knee replacement surgeries performed has decreased in regions of England with restrictions on surgery for overweight patients, with people in the most disadvantaged areas most affected.
Patients who need surgery but cannot lose weight are denied surgery that could relieve pain and increase mobility, the University of Bristol team said.
Health activists expressed alarm, alleging that the policy was a “blunt tool” used to replace conversations between doctors and patients and ran the risk of exacerbating health inequalities.
Over the past decade, some clinical commission groups (GCCs) have introduced rules across England to restrict access to hip and knee replacement surgery for overweight or obese patients.
There are significant regional differences, with stricter GCCs telling patients that they must reach a certain body mass index (BMI) before surgery can be performed or forced to a waiting time. Others impose no restrictions.
The study, funded by the National Research Institute for Health and Care, suggests that regions that introduced policy changes for access to knee replacement surgery based on weight or A patient’s BMI have experienced a decrease in surgery.
The researchers analyzed the rates of knee replacement surgery of 481,555 patients between January 2009 and December 2019, before the Covid pandemic arrived, using data from the National Joint Registry and compared regions with and without a BMI policy. / weight.
The study found that more than two-thirds of GCCs in England had a BMI policy for knee replacement surgery, with 61% of these policies denying access to surgery or requiring a time-out period. ‘wait extra. He said surgery was down 14% overall than would have been expected if policies that restricted access had not been introduced.
By looking at patients ’zip codes, the researchers were able to see that people from more disadvantaged areas seemed more likely to be denied surgery.
Lead author Joanna McLaughlin of Bristol Medical School said: “Our study raises concerns that these policies are related to worsening health inequalities with fewer NHS operations for less affluent groups.
“We could see surgery rates going down for the most disadvantaged, but going up for those in better condition, which correlates with more private surgery in these areas.”
He said it was not helpful to choose particular CCG figures as local factors could skew the data. But it is clear that different approaches are being taken to neighboring areas. South Lincolnshire, for example, has more liberal rules, while the requirements are stricter on the north side of Norfolk.
The report says that with one in 10 people likely to need a knee replacement, many thousands of patients are affected.
Jacob Lant, head of policy, association and research at Healthwatch England, said: “Strong use of BMI in this way is not helpful and should be treated as a guideline rather than a harsh rule and What really needs to happen is a conversation between doctors and patients about the patient’s specific circumstances.
“Weight loss can be incredibly difficult, especially for those whose mobility is already affected by problems with their joints.”
The study, titled What effect have NHS commissioners ’policies had on body mass index in access to knee replacement surgery in England? – has been published in the journal PLOS ONE.
Professor John Skinner, a board member of the Royal College of Surgeons of England and consultant orthopedic surgeon, said: “Hip and knee replacement surgery for osteoarthritis leads to a dramatic improvement in quality of life. Surgical decision making should be made individually for each patient.
“Restrictive referral policies, such as BMI thresholds, penalize patients who become more immobile and then are likely to suffer more health problems. Good guidelines clearly state that the should not be restricted. access to joint replacement based on BMI, smoking or other characteristics.
“This research paper confirms that restricting access to surgery for BMI reasons has a significant effect on access to care and worsens inequalities.
“It is reasonable to encourage weight loss when appropriate and most hospitals operate a system to encourage weight loss in patients with a BMI of 40. However, this research shows that if commissioners restrict access to patients with a high BMI, variability and much greater inequality occurs among patients “.
A spokesman for the Department of Health and Welfare said: “We are helping local authorities improve public health by increasing their subsidy to just over £ 3.4 billion this year, and we are investing £ 39 billion more in health and care. over the next three years. ”
An NHS spokesman said: “Patients and doctors work together before surgery to optimize the chances of getting the best result and in some cases losing weight before surgery reduces the risk to patients and improves chances of success of the procedure “.