Patterns of health risk factors in people waiting for elective surgery in the North East and North Cumbria
Evidence Hub
Patterns of health risk factors in people waiting for elective surgery in the North East and North Cumbria
Key points
- Adults from poorer areas have more of the health risk factors that prevent routine operations, such as joint replacements, from going ahead.
- The most common risk factors are excess weight, smoking, high blood pressure, and high blood sugar.
- Health leaders should focus on pre-operation support for these conditions, and in areas of deprivation, to help people to be fit for surgery, sooner.
- Not doing so could mean that patients’ health can worsen as they wait for surgery, or they miss their surgery as they are too high risk on the day (e.g. their blood sugars are too high which would make their operation dangerous).
You can download a briefing paper for this work, below.
Quick-read summary
Health risk factors such as smoking, obesity, and high blood sugar are sometimes used by policy makers as eligibility criteria for surgery. For example, patients with obesity may be told to lose weight before they can have surgery.
We carried out a study to determine how many patients in the North East and North Cumbria waiting for straightforward surgeries (like hernia repairs or joint replacements) have these risk factors. We also looked at how this was spread across social groups. We used data from the Rapid Actionable Insight Driving Reform (RAIDR) database which links primary and secondary care elective waiting list data the North East and North Cumbria.
We analysed data from 78,571 patients. The most common risk factors were obesity (3 in 10 patients), high blood pressure (3 in 10 patients), high blood sugar (1 in 6 patients) and smoking (1 in 7 patients). They were significantly more common in more deprived patients. These risk factors are often used as eligibility criteria for elective surgery.
We recommend that surgical care and surgery eligibility criteria is designed and delivered with deprivation in mind, otherwise the most deprived people in society may find it difficult to access surgery and become even more unwell.
Who is this evidence useful for?
Commissioners and policy makers involved in the delivery of surgical care.
Research summary
What is the issue?
Approximately 7 million operations take place each year in the NHS. Around 60% of surgery patients need straightforward surgeries like hernia repairs or joint replacements.
Policy makers sometimes apply eligibility criteria for these surgeries. These criteria are often based on health risk factors like obesity and smoking status. For example, patients with obesity must lose weight before they can have surgery.
In a general population, people from more deprived backgrounds tend to have more health risk factors. This may make it harder for them to access the surgery they need.
People living in areas of greater socioeconomic deprivation also appear at a younger adult age on surgery waiting lists and are living with significantly more comorbidities.
We have limited knowledge on the patterns of risk factors in people waiting for surgery.
What did we do?
We analysed data of people waiting for straightforward surgeries in the North East and North Cumbria by accessing the Rapid Actionable Insight Driving Reform (RAIDR) database which links primary and secondary care elective waiting list data.
We used these data to find out how many patients were living with the following health risk factors:
- Smoker
- Obesity (BMI ≥ 30 kg/m2)
- Type 2 diabetes mellitus (T2DM)
- Atrial fibrillation
- Chronic obstructive pulmonary disease (COPD)
- Hypertension
- Having a serious mental illness
- Having a learning disability
We looked the odds of having these risk factors across social groups based on the England Index of Multiple Deprivation score.
What the research found
- Of the 78,571 patients included in our study, 30% percent of patients were from the most deprived groups of society.
- The most common risk factors were obesity (29.4%), hypertension (28.9%), smoking (13.5%) and T2DM (16.6%).
- The most advantaged patients were twice as likely to have no risk factors than the most deprived patients, even though the most deprived patients were younger.
- As deprivation increased, the odds of having many of the risk factors increased in a dose-response manner.
- The relationship with deprivation was strongest for being a smoker, having a learning disability, having a serious mental illness and COPD.
Key learning and recommendations
- The most prevalent risk factors in our sample (obesity, high blood sugar, high blood pressure and smoking) were more common in more deprived patients. These risk factors are commonly used as eligibility criteria for elective surgery.
- Perioperative services and surgery eligibility criteria must be designed with socioeconomic deprivation in mind to avoid widening health inequalities.
- Prehabilitation services that target obesity, hypertension and smoking can help to get patients ready for surgery and reduce the risk of widening health inequalities.
Further recommendations
- Surgery represents an opportunistic ‘teachable moment’ where patients may be more motivated to improve their health.
- Policymakers and service commissioners can act on this teachable moment, and the time spent waiting for surgery, to plan sustainable, targeted provision of services to address health risk behaviours and medical conditions.
- Prehabilitation interventions could be integrated into usual perioperative care in areas of greater deprivation to improve eligibility for surgery, surgical outcomes, and longer-term health.
- Focusing prehabilitation where there is deprivation would be important as there is normally greater uptake of preventative measures by people who are less deprived.
- Our recent review found that prehabilitation interventions reduced length of stay (especially for patients undergoing lung surgery), pre-surgery and early post-surgery functional capacity and smoking cessation, and longer-term smoking cessation across surgical specialties.
- A more proactive model of care providing even earlier intervention in patients on non-admitted pathways could potentially provide greater benefit still, for example, downgrade to a lower severity surgery or eliminate the need for surgery completely.
Related information
Figure: Proposed pathway showing how socioeconomic deprivation can generate and amplify inequalities in health (surgery risk factors and surgery outcomes) and care (access to surgical services) in patients needing surgery.
Download a briefing paper for this work, below.
Get in touch about this research
Dr Mackenzie Fong
Read the full research paper
Acknowledgments
This research was supported by the National Institute for Health and Care Research (NIHR) Applied Research Collaboration (ARC) North East and North Cumbria (NENC) and the NIHR Leicester Biomedical Research Centre. We thank NECS for their role in providing carefully controlled access to the data, NENC Integrated Care Board (ICB) for providing the funding and leadership of the Waiting Well programme, and The Waiting Well programme board.