Age, obesity drive growth in joint replacements
Becky Rynor Canwest News ServiceWednesday, March 26, 2008
OTTAWA - An older and increasingly heavier population has led to a doubling - and in some age groups even a tripling - in the number of Canadians who have had their hips or knees replaced over the past decade, a new report from the Canadian Institute for Health Information reveals.
"Some of it is the need and the population," Kathleen Morris, one of the authors of the study, said Wednesday. "As the population is aging, we're seeing an increased prevalence of conditions like arthritis, like increased body weight, that are predisposing factors for needing a joint replacement."
Morris said 74 per cent of hip replacement patients and 88 per cent of knee replacement patients were found to be overweight or obese.
"The extra weight creates more wear and tear on the joints," she said, adding "obesity is a factor that contributes to a number of significant health problems and any efforts to improve healthy body weight would have payoffs in many health areas."
In 2004, Canada's first ministers also identified joint replacement as a priority for wait-time reduction. In 2005-2006, the first fiscal year following the agreement, the number of hip and knee replacements grew by 17 per cent, with 68,746 surgeries. The institute says that represents a doubling over the past decade.
"So there's extra emphasis on trying to reduce waits and the strategy many provinces use for that is to provide more surgeries," Morris said. However she said that the increase has not come at the cost of other critically needed surgeries, adding that previous CIHI studies looked at rates of all other surgeries across Canada and found there were no declines.
While joint replacements are among the most common elective surgeries performed in Canada, the institute also warned they are still major surgical procedures "that are not without risks."
For the first time, CIHI looked at the number of joint replacement patients who have to be readmitted to hospital due to infections or other complications, including having the entire surgeries redone.
The study looked at 51,000 patients who had a hip or knee replaced in 2005-2006. It found that almost 8,000 patients, or one in seven, were readmitted at least once within one year of the operation, usually for complications such as loosening of the replacement joint, dislocation or infection.
Only one per cent, or 780 patients, were readmitted to have the entire procedure repeated.
"This is one of the first times in Canada that we have known how many patients return to the hospital and for what reasons. And that's the first step in understanding what some of the opportunities for quality improvement might be."
The study also found that men were slightly more likely than women to be readmitted for post-surgery infection.
The costs associated with readmitting people within a year of their elective joint replacement surgeries are estimated to be about $45 million.
"I think we need to understand whether any of those returns can be prevented," Morris said. "As the number of joint replacements surgeries grow, we're looking for a system that's as efficient and effective as it can be in order to accommodate that growth. So anything we can do to improve the quality or reduce the number of people who are rehospitalized after surgery would be good for the system, good for surgeons, good for patients."
The report also predicted that the "tremendous growth" in the number of hip and knee replacements in Canada is likely to continue.
The institute is an independent organization that collects and analyzes information on health care in Canada.
©Canwest News Service 2008
