Evidence map›Paper›PMID 37308999›Full record

ArticleBMC medicine2023

What effect have commissioners' policies for body mass index had on hip replacement surgery?: an interrupted time series analysis from the National Joint Registry for England.

Joanna McLaughlin, Ruth Kipping, Amanda Owen-Smith, Hugh McLeod, Samuel Hawley, J Mark Wilkinson, Andrew Judge

Open access · goldAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in BMC medicine, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.

0numbers the graph read from it
0cells of the map it votes in
4citing papers in PubMed
1.6field-weighted citation impact, top 17% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

4 citing papers in PubMed, 5 citations in OpenAlex.

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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

7 authors at 4 institutions in 1 country.

Joanna McLaughlinMusculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Learning and Research Building, Level 1, Southmead Hospital, Bristol, BS10 5NB, UK. joanna.mclaughlin@bristol.ac.uk.ORCID 0000-0001-9921-4698
Ruth KippingPopulation Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 2PS, UK.ORCID 0000-0002-5446-8077
Amanda Owen-SmithPopulation Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 2PS, UK.ORCID 0000-0003-1188-2371
Hugh McLeodPopulation Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 2PS, UK.ORCID 0000-0002-2266-7303
Samuel HawleyMusculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Learning and Research Building, Level 1, Southmead Hospital, Bristol, BS10 5NB, UK.ORCID 0000-0002-7034-6168
J Mark WilkinsonDepartment of Oncology and Metabolism, The Mellanby Centre for Musculoskeletal Research, University of Sheffield, Metabolic Bone Unit, Sorby Wing, Northern General Hospital, Sheffield, UK.ORCID 0000-0001-5577-3674
Andrew JudgeMusculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Learning and Research Building, Level 1, Southmead Hospital, Bristol, BS10 5NB, UK.ORCID 0000-0003-3015-0432
Southmead Hospital · GBUniversity Hospitals Bristol NHS Foundation Trust · GBUniversity of Bristol · GBNorthern General Hospital · GB

Funding

Department of Health NIHR 301469
6 · The paper itself

Abstract

backgroundDespite their widespread use, the impact of commissioners' policies for body mass index (BMI) for access to elective surgery is not clear. Policy use varies by locality, and there are concerns that these policies may worsen health inequalities. The aim of this study was to assess the impact of policies for BMI on access to hip replacement surgery in England.

methodsA natural experimental study using interrupted time series and difference-in-differences analysis. We used National Joint Registry data for 480,364 patients who had primary hip replacement surgery in England between January 2009 and December 2019. Clinical commissioning group policies introduced before June 2018 to alter access to hip replacement for patients with overweight or obesity were considered the intervention. The main outcome measures were rate of surgery and patient demographics (BMI, index of multiple deprivation, independently funded surgery) over time.

resultsCommissioning localities which introduced a policy had higher surgery rates at baseline than those which did not. Rates of surgery fell after policy introduction, whereas rates rose in localities with no policy. 'Strict' policies mandating a BMI threshold for access to surgery were associated with the sharpest fall in rates (trend change of - 1.39 operations per 100,000 population aged 40 + per quarter-year, 95% confidence interval - 1.81 to - 0.97, P < 0.001). Localities with BMI policies have higher proportions of independently funded surgery and more affluent patients receiving surgery, indicating increasing health inequalities. Policies enforcing extra waiting time before surgery were associated with worsening mean pre-operative symptom scores and rising obesity.

conclusionsCommissioners and policymakers should be aware of the counterproductive effects of BMI policies on patient outcomes and inequalities. We recommend that BMI policies involving extra waiting time or mandatory BMI thresholds are no longer used to reduce access to hip replacement surgery.

Indexed as

ObesityPolicyBody Mass IndexEnglandHumansInterrupted Time Series AnalysisRegistriesCommissioningEpidemiologyHealth policyHip replacementObesityOsteoarthritis

Identifiers

PMID37308999
PMCPMC10260274
OpenAlexW4380356021

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.