Willingness of patients to change surgeons for a shorter waiting time for joint arthroplasty

Abstract

Background: To improve access to care, many jurisdictions have proposed waiting-time benchmarks and guarantees. We assessed the willingness of patients to consider changing their surgeon to one with a shorter waiting time for arthroplasty.

Methods: We mailed a questionnaire to 2 random samples of patients who either were awaiting hip or knee replacement arthroplasty or had had one of these procedures within the preceding 3-12 months. We used logistic regression to assess the determinants of patients' likelihood to consider changing surgeons.

Results: Of 1200 responses from a sample of 2000, 557 (46%) were from patients awaiting surgery and 643 (54%) were from people who had undergone surgery. The mean age of respondents was 69.9 years (standard deviation 10.8), and 682 (57%) were women. The median waiting time for surgery was 8 months. Overall, 753 (63%) of the patients were unlikely to consider changing surgeons. Increased likelihood of changing surgeons was associated with male sex (adjusted odds ratio [OR] 1.49, 95% confidence interval [CI] 1.10-2.02), a high school education or higher (OR 1.73, 95% CI 1.15-2.62) and having already undergone surgery (OR 1.71, 95% CI 1.19-2.46). Decreased likelihood was associated with preference for a particular surgeon before referral (OR 0.57, 95% CI 0.42-0.79), a better score on the EuroQol (EQ-5D) index (a measure of health-related quality of life) (OR 0.39, 95% CI 0.24-0.66), perception that the waiting time to see the surgeon was acceptable (OR 0.50, 95% CI 0.36-0.70), perception that the waiting time to surgery was acceptable (OR 0.62, 95% CI 0.43-0.91) and perceived fairness of treatment (OR 0.53, 95% CI 0.36-0.78).

Interpretation: Despite long waits for surgery, most patients, if given the choice, would be unlikely to change their surgeon to one with a shorter waiting time.

Box 1

Figure 1: Flow diagram showing selection of patients to receive survey about willingness to change surgeons, return of surveys, and identification of surveys with sufficient data for analysis.

Figure 2: Adjusted odds ratios for logistic regression model of the determinants of patients' likelihood of changing surgeons to one with a shorter waiting time for joint arthroplasty. OR = odds ratio, CI = confidence interval.