The number of knee replacement operations decreased after the NHS introduced policies based on a patient’s weight, a UK study has found.
By introducing weight/body mass index (BMI) policies, NHS clinical commissioning groups (CCGs) in England may be contributing to health inequalities, say researchers from the University of Bristol, UK.
They are now calling on commissioners and policy decision-makers to reconsider restrictive policies that affect access to elective surgery as a matter of urgency.
Writing in PLOS ONE, they also suggest the recently formed Integrated Care Systems from existing CCG groups should be an important opportunity for positive changes to policy position.
While these policies have been brought in over the past 10 years, there is significant regional difference, with some regions having no policy while others deny patients access to an elective hip or knee replacement operation until their BMI is below a certain threshold.
Using data from the National Joint Registry, the researchers analysed the rates of knee replacement surgery of 481,555 patients between January 2009 and December 2019 to compare regions.
Policies put in place by NHS CCGs to change access to knee replacement based on a patient’s weight/BMI were linked with a decrease in surgery and could have led to postcode health inequalities, they found.
Rates of surgery fell in all patient groups, and not just for overweight or obese patients.
Lead author Dr Joanna McLaughlin, National Institute for Health and Care Research (NIHR) doctoral fellow in the Bristol Medical School: Translational Health Sciences (THS), said: “NHS policy on whether people can immediately access referral for knee replacement surgery if they are overweight or obese varies depending on where you live in England.
“Our study raises the concern that these policies are linked with worsening health inequalities with fewer NHS operations for the least affluent groups in society when policies are introduced.”
The study was funded by NIHR.
McLaughlin J et al. What effect have NHS commissioners’ policies for body mass index had on access to knee replacement surgery in England?: An interrupted time series analysis from the National Joint Registry. PLOS ONE 30 June 2022; doi: 10.1371/journal.pone.0270274
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