SSM Research Summary Competition 2023 Doctoral winner

The Society for Medicine and Public Health ran this year a writing competition for the

best research summary based on work presented at SSM in the past two years.

Congratulations to Joanna McLaughlin for winning one of the two places offered for the SSM Research Summary Competition 2023! Joanna McLaughlin is a Doctoral Fellow and Specialty Registrar in Public Health, based at the University of Bristol.

Read her winning entry here:

Research Summary Title: Patients should not be excluded from referral to joint replacement surgery due to their body mass index

The introduction of ‘health optimisation’ interventions into the pathway to elective surgery is becoming increasingly common in the NHS – particularly for joint replacement. These policies aim to reduce surgery, improve patient safety and outcomes, and encourage lifelong behavioural changes. Some patients living with obesity face regional policies which include mandatory extra waiting periods or body mass index (BMI) thresholds for surgical referral. Such policies may exacerbate health inequalities and require further investigation.

The research

After reporting on the high prevalence of BMI policies in England (published in BMC Health Services Research), we conducted studies into the impact of policy introduction on access to elective joint replacement surgery. The study on knee replacement is published in PLOS ONE and on hip replacement in BMC Medicine*. As different regions had introduced policies at different times, policy (intervention) and non-policy (control) regions can be compared in a natural experimental design. The study used data from the National Joint Registry and included almost 1 million patients aged 40 years and above who had a primary knee or hip replacement between January 2009 and December 2019.

Initially, there was an increasing rate of surgery across all regions as would be expected wit

h England’s ageing and increasingly obese population. However, the BMI policy introduction was associated with reductions in surgery and an increase in the proportion of privately funded surgery. The results suggest that BMI policies contribute to health inequalities and limit access to surgery for certain patient groups.

The policy impact

The key messages from our findings have been reported on by the mainstream media (“

Knee replacements stall in regions of England with weight rules for patients – The Guardian”), and highlighted in several NHSE outputs aimed at clinicians, policy-makers and commissioners, including a podcast with the Deputy Director for the Centre for Perioperative Care. There are encouraging signs that policymakers are following our recommendations to review their use of restrictive policies (“Ban on hip and knee ops for obese patients and smokers could be scrapped”). NICE’s guidance on osteoarthritis October 2022 update also clearly states that BMI should not be used to exclude people from surgical referrals. We can be hopeful that the policy direction is improving, with a focus on increasing the reach of promising, non-restrictive, surgical prehabilitation programmes such as the PREP-Well programme.

Oral Presentation linked to the research summary:
Patients should not be excluded from referral to joint replacement surgery due to their body mass index

Publication linked to the research summary:

McLaughlin, J., Kipping, R., Owen-Smith, A. et al. 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. BMC Med 21, 202 (2023). https://doi.org/10.1186/s12916-023-02899-3

Acknowledgements
This research is funded by the National Institute for Health and Care Research (NIHR) – JM holds an NIHR Doctoral Research Fellowship (301469). The views expressed are those of the authors and not necessarily those of the NIHR, National Joint Registry or the Department of Health and Social Care.