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BMI limits on knee ops cut overall surgery rates and increase inequalities, finds study

BMI knee

Policies to limit access to knee replacement surgery on the basis of BMI have led to a decrease in knee replacement operations and may be contributing to health inequalities, researchers have concluded.

Currently around 70% of CCGs restrict access to joint replacement based on weight in some form but policies vary from denying referral to an operation until a patient’s BMI is below a certain threshold and others having no restrictions.

Writing in PLoS ONE, researchers from Bristol University said the Royal College of Surgeon’s states that commissioning policies should be based on clinical need and not factors such as BMI.

Analysing data from the National Joint Registry of more than 480,000 patients in England between 2009 and 2018, they found a sustained fall in rates of surgery after BMI policies were introduced.

But in areas where no such policy was in place, the rate of operations increased.

Three years after policies limiting access on the basis of weight were put in place, there were 10.5 per 100,000 population fewer operations per quarter in those aged 40 and over, representing a fall of 14.1% from the rate expected had there been no change in trend.

The study also showed that rates of surgery fell in all patient groups, including non-obese patients after BMI policies were introduced.

In addition, the proportion of private operations increased after policies came in, as did the measure of socioeconomic deprivation of patients, they reported.

The researcher urged commissioners and policy decision-makers to reconsider restrictive policies that affect access to elective surgery as a matter of urgency.

They added that as Integrated Care Systems take over from CCGs, it may provide an important opportunity to change policy.

There are currently 6.5 million people on the elective waiting list.

Study leader Dr Joanna McLaughlin, an NIHR doctoral fellow at Bristol Medical School 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.’

Commenting on the study, an NHS spokesperson told the Independent: ‘Patients and clinicians work together prior to surgery to optimise the chance of getting the best outcome and in some cases, losing weight prior to surgery reduces risk to patients and improves the chances of success for the procedure.

‘The NHS is focused on reducing waiting times for knee replacements and overall, since the elective recovery plan was published in February, the number of people waiting more than two years for treatment has dropped by two-thirds.’