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Obese patients should not be denied hip ops

By Nerys Hairon

The NHS should not deny obese patients hip replacement sur-gery simply on the basis of weight, a new study concludes.

The research found obesity did not affect a patient's long-term outcomes after surgery ­ with the severity of disease a much more important factor.

The findings cast serious doubt on the policies of some PCTs, which have sought to bar obese patients from surgery. Three East Suffolk PCTs provoked outrage among GPs in December when they restricted hip and knee replacements to patients with a BMI below 30.

NICE ruled in December that 'it may be appropriate' to restrict access to treatment for some self-inflicted conditions that influenced clinical- or cost-effectiveness.

But the new research found a BMI over 28 did not predict decline in physical function, vitality or mental health in patients who underwent surgery. Instead, reporting of pain in multiple joints at the start of the study was the critical predictor.

Study leader Professor Cyrus Cooper, professor of rheumatology at the University of South-ampton, said: 'What this makes the case for is not using obesity at baseline as a predictor of long-term functional outcome. You should not deny surgery to an obese person because you think the surgery will not do them any good.'

Dr David Haslam, clinical director of the National Obesity Forum and a GP in Watton-at-Stone in Hertfordshire, said: 'What I think this shows is that at the lower end of obesity, a BMI of 30 plus, it really should not necessarily be a contraindication to surgery.'

Dr Haslam said decisions should be made on a case-by-case clinical basis and not on financial grounds.

Dr Gill Jenkins, a GP with an interest in obesity in Bristol, said: 'I don't think we should be using BMI solely, in the way that some PCTs and trusts are limiting access to surgery. This study shows you have to consider other relevant factors above obesity.'

The study, presented at the British Society for Rheumatology annual meeting in Glasgow this week, studied 324 patients with hip osteoarthritis.

NICE ruling on self-inflicted treatments

· NICE and its advisory bodies should avoid denying care to patients with conditions that are, or may be, self-inflicted

· If, however, self-inflicted causes influence the clinical-

or cost-effectiveness of an intervention, it may be appropriate to take this into account

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