Purpose

To determine the impact of wait times for arthroscopic knee surgery on a patient’s health-related quality of life (HRQoL).

Introduction

Despite the numerous advantages found in publicly funded health care systems, extensive wait times for elective surgery often occur due to limited resources. Numerous studies have examined the negative effects of delayed surgery on functional outcomes; however, few studies have attempted to characterize the wait time experience of patients in terms of HRQoL.

Method

A prospective cohort study design was used to evaluate changes in HRQoL for “Wait time 2”: the time between the decision to operate (DTO) on a patient and the day of surgery (DOS) for patients undergoing arthroscopic surgery on their knee. Patients completed the International Knee Documentation Committee (IKDC) demographic, current health assessment, and subjective knee evaluation forms on the day the DTO was made and again on the DOS. A paired two-sample t-test assuming equal variances was performed for the entire cohort (N=240). A sub-group analysis using an independent two-sample t-test assuming unequal variances was used for patients that waited less than 3 months (N=185) for surgery and those that waited 3 months or more (N=55). Applying the Bonferroni correction, statistical significance was set at p<0.005 to account for multiple testing.

Results

The mean age of patients in the entire cohort was 29.10 years (SD 14.08) with a mean wait time of 64.63 days (SD 47.23) for surgery. The most common indication for surgery (50.8%) was anterior cruciate ligament rupture and a majority of patients were male, 136 (56.7%). The mean subjective knee evaluation score was graded as poor (<70) at both time points, however, there was a significant improvement in this score between the DTO and DOS in the total cohort (p<0.001). There was no significant difference in the subjective knee evaluation score between patients waiting greater or less than 3 months for surgery (p=0.72). The following subscale scores of the current health assessment form significantly improved during the wait for surgery in the total cohort: energy/fatigue (p<0.001), bodily pain (p<0.001), general health perceptions (p<0.001), and the PCS score (p<0.001). However, there were no significant changes noted in: physical functioning, role limitations due to physical health, role limitations due to personal or emotional problems, emotional well-being, social functioning, and the MCS score.

Conclusion

Although there may be some benefit in being assessed by an orthopedic specialist for certain aspects of HRQOL, the emotional and social health of the patient remains poor as does their function during the wait for surgery. Solutions to improve this situation may include more timely surgery, and perhaps co-intervention shortly after the DTO is made with a specialist that can help patients with emotional and social health issues.