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Living with deprivation can increase your chance of missing out on surgery

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.

A new study supported by the National Institute for Health and Care Research (NIHR) Applied Research Collaboration (ARC) North East and North Cumbria (NENC) and published in BMJ Open has found that adults who live in deprived areas tend to have more health risk factors that make it difficult for them to access the surgery they need.

The research team have called for health leaders to focus on pre-operation support for these groups, to help them to improve their health more quickly and be fit for surgery, sooner.

Around 7 million operations take place each year in the NHS, with around 60% of patients on surgery lists who need a straightforward operation like hernia repairs or joint replacements.

There are sometimes eligibility criteria for these surgeries which are based on health risk factors like obesity and smoking status. For example, patients may have to lose weight before they can have an operation.

However, because adults from more deprived backgrounds tend to have more health risk factors, it means they’re more likely to miss out on surgery they need, or their surgery is delayed because health conditions aren’t under control.

Where you live increases your risk

The North East and North Cumbria, home to 3.1 million people, is one of the most deprived regions in England.

Deprivation is measured using factors such as income, employment status, levels of education, skills and training, disability, housing, and living environment.

Researchers analysed the health information of people waiting for straightforward surgeries in the North East and North Cumbria, to explore how many patients were living with health risk factors that would prevent them from having an operation.

The most common risk factors seen in patients waiting for routine surgery were excess weight, smoking, high-blood pressure, and high blood sugar (uncontrolled type 2 diabetes).

The team then compared risk factors with information about where patients lived in the region, to determine the levels of deprivation that they experience.

The research found clear links between higher levels of deprivation and a higher chance of having one or more of the risk factors that could prevent surgery – with 64 percent of patients in the most deprived areas having at least one risk factor.

This means that these patients may wait longer for a routine operation, which can often lead to their health becoming worse.

Patients who lived with little disadvantage were twice as likely to have no risk factors than the most deprived patients, so had fewer barriers to surgery.

Call for targeted support

Dr Mackenzie Fong from the NIHR ARC North East and North Cumbria was part of the study team.

She said: “Health leaders need to think about the impact of deprivation when they are designing and delivering services around surgery, or the health of patients living in areas of deprivation could be worsened.

“If we can offer targeted support around the most common risk factors of weight, smoking and high-blood pressure, we can help more people to be fit for surgery, sooner, and avoid delays that could end up making health worse.

“This kind of targeted support could also help to make the NHS more efficient, by avoiding unplanned delays to operations due to risk factors that aren’t under control.”

Read a plain language summary of this study

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.