Prioritization of patients for surgery in Canada: The case of hip and knee replacement surgeries in Newfoundland

Background: Single-entry models (SEM) improve wait times for hip and knee replacement, but little is known whether prioritization implemented in SEM can help meet the benchmarks for consolation/surgery. This study aimed to determine the impact of prioritization on receiving consultation and surgery within the benchmarks. Methods: This is a retrospective cohort study for which two administration databases were linked. Logistic regression was used to investigate the impact of prioritization on receiving consultations and surgery within the benchmarks of 90 and 182 days, respectively, adjusting for patients' characteristics and preference for surgeon. Results: 1,967 patients were included in this study. The odds ratios of having consultation within 90 days for hip replacement patients in priorities 1 and 2 (high priority) were 57.24 (CI: 23.16-141.47) and 14.63 (CI: 6.44-33.25), respectively, compared with those in priority 3. For knee replacement, patients with higher priority were more likely to have consultation within 90 days. Although priority levels were not related to having surgery within 182 days for knee replacement, hip replacement patients with priority 1 (CI: 0.2-0.75) and 2 (CI: 0.16-0.54) were less likely to have surgery within 182 days, compared with those with priority 3. Conclusion: Patients with high priority levels were more likely to have consultation within 90 days for hip and knee replacements. SEM may not help have surgery within 182 days. Prioritization has no impact on receiving surgery within 182 days for knee replacement, but hip replacement patients with high priority were less likely to have surgery within 182 days.