The study examines the impact of TKA cancellations in UK hospitals

The study examines the impact of TKA cancellations in UK hospitals

Thousands of NHS knee replacement surgeries are canceled at short notice every year, many for avoidable reasons, according to a new study published today [1 December]. This is costing the NHS millions of pounds and increasing waiting times for patients, many of whom are in severe pain.

The study, led by researchers from the Bristol Biomedical Research Center (Bristol BRC) at the University of Bristol's National Institute for Health and Care Research (NIHR) and sponsored by North Bristol NHS Trust, was published inThe Bone and Joint Journal.

The NIHR-funded study collected information on the timing and reasons for cancellation of total knee replacement surgery in six NHS hospitals in England, Scotland, Wales and Northern Ireland over a five-year period between April 2018 and March 2023.

The study found that 17,223 total knee replacement surgeries were completed and 9,403 were canceled at the six hospitals over the five years - more than previously thought. This is the first study to track total knee replacement cancellations in more than one hospital.

Each operation canceled at short notice costs the NHS a lost rate of between £6,500 and £11,000. This adds up to over £15.5 million across the six hospitals over five years.

A quarter of the cancellations occurred less than 24 hours before surgery and almost a third occurred within 2 to 14 days. Cancellations the day before or on the day of surgery may result in empty operating rooms that are difficult to fill. Rescheduling these operations will add to the NHS's already long waiting lists.

Canceled surgeries and longer wait times can impact patients' quality of life and make them feel rejected. Patients on the waiting list experience a significant decline in their quality of life after waiting 6 to 12 months for a knee replacement – ​​a quarter say they are waiting in a state “worse than death,” according to previous studies.

Lack of available hospital beds and patients' inability to undergo surgery were the most common reasons for short-term cancellations. Many of these cancellations could have been avoided with advance planning.

Heart problems, infections and wounds were the main health reasons for canceling surgery. With the right medical care while people wait for their surgery, many patients could be helped to become medically fit for surgery and cancellations could be avoided.

The scale of this problem is huge. Knee replacement surgery is one of the most common surgical procedures. Over 110,000 knee replacement surgeries are carried out in the UK every year. More than 3 million people are currently waiting more than 18 weeks for non-urgent NHS surgery.

This highlights the urgent need for efficiency programs in the NHS and national healthcare planning for patients on waiting lists to prevent cancellations.

Aborted operations are not just a waste of resources. Each cancellation statistic represents a patient who has often risked their entire life to come to the hospital, carefully followed preparation advice, arranged transportation, and found someone to care for their loved ones, often at great cost to themselves.

So I think it's unforgivable that we don't do the surgery after everything they've been through.

We should be aiming for zero avoidable cancellations and projects like this are the first step in achieving this across the NHS. Until we know what causes cancellations, we can’t realistically assume that they will just stop.”

Dr. Mark Eveleigh, consultant anesthetist at Gloucestershire Hospitals NHS Foundation Trust

Michael Whitehouse, Professor of Trauma and Orthopedics at the University of Bristol and co-author of the paper, said: "This work has highlighted a significant and underestimated problem for the large number of patients awaiting joint replacement surgery."

"The pathways patients must follow are often complicated and difficult to navigate, even until they are placed on a waiting list for surgery. As our patient who participated in this study highlighted, cancellations are not harmless temporary blips and can result in significant unwarranted delays."

“The Getting It Right First Time program highlights the need for fenced beds to protect activities such as joint replacements. However, the most common institutional reason for refusal was lack of a bed for the patient to go to.

“The most common clinical reasons for cancellations are problems that can be identified in advance and this would allow the operative period to continue to be used productively to care for another patient if properly designed care pathways were put in place to better support our patients for the benefit of all.”

Peter Aitken, patient and public official involved in the research, said:“My knee replacement surgery was originally scheduled for November 2023, but was canceled after my check-up appointment due to the blood thinning medication I was taking at the time.

"The appointment was rescheduled for March 2025 and I went to the hospital that day. However, after a seven and a half hour wait, when I was ready to get my gown, I was told at the eleventh hour that the operation had to be canceled because they had run out of time."

Dr. Wendy Bertram, study leader and Senior Research Associate in Musculoskeletal Health Services Research at the University of Bristol, added: “This study shows that knee replacement surgery is being canceled much more frequently than we thought.”

"There are many statistics in our publication - each one represents a person who has waited a long time for a procedure to relieve their pain. Many people wait a year or more, enduring lives on hold because they are unable to make plans or do the things they enjoy."

"The light at the end of the tunnel is their business, but cancellation quickly undoes that. We can do better for these people. That's why we're using the information from this study to develop programs that prevent cancellations and support people while they wait."

Health Minister Karin Smyth said: "This study shows the shocking extent of canceled knee operations - thousands of patients are left waiting in pain. Each cancellation is not just a statistic but means a person's quality of life is being put on hold, which is unacceptable."

"That's why we're investing in our NHS to reduce cancellations, including by shortening hospital stays to free up beds, building new surgical centers and giving patients more control over their appointments using tools such as the NHS app. When patients have control over when their treatment takes place and are informed about how to prepare for surgery, rather than the NHS's 'take it all or all together' approach as they have in the past, they are more likely to minute cancel, far less – better for them and better for the NHS.”

"We are also rolling out the NHS Federated Data Platform to 85% of acute trusts by March 2026, which will give frontline staff a complete view of their operational systems in one place, helping them plan staff and resources more efficiently to meet demand. We know there is more to do, but our investment and modernization agenda is aimed at building a future-ready NHS."

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