{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,2]],"date-time":"2026-04-02T06:04:58Z","timestamp":1775109898194,"version":"3.50.1"},"reference-count":34,"publisher":"BMJ","issue":"5","license":[{"start":{"date-parts":[[2023,5,16]],"date-time":"2023-05-16T00:00:00Z","timestamp":1684195200000},"content-version":"unspecified","delay-in-days":15,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100023699","name":"Health Data Research UK","doi-asserted-by":"crossref","award":["N\/A"],"award-info":[{"award-number":["N\/A"]}],"id":[{"id":"10.13039\/501100023699","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2023,4,18]]},"published-print":{"date-parts":[[2023,5]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To explore the impact of a temporary cancellation of elective surgery in winter 2017 on trends in primary hip and knee replacement at a major National Health Service (NHS) Trust, and whether lessons can be learnt about efficient surgery provision.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design and setting<\/jats:title>\n                    <jats:p>Observational descriptive study using interrupted time series analysis of hospital records to explore trends in primary hip and knee replacement surgery at a major NHS Trust, as well as patient characteristics, 2016\u20132019.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Intervention<\/jats:title>\n                    <jats:p>A temporary cancellation of elective services for 2\u2009months in winter 2017.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Outcomes<\/jats:title>\n                    <jats:p>NHS-funded hospital admissions for primary hip or knee replacement, length of stay and bed occupancy. Additionally, we explored the ratio of elective to emergency admissions at the Trust as a measure of elective capacity, and the ratio of public to private provision of NHS-funded hip and knee surgery.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>After winter 2017, there was a sustained reduction in the number of knee replacements, a decrease in the proportion of most deprived people having knee replacements and an increase in average age for knee replacement and comorbidity for both types of surgery. The ratio of public to private provision dropped after winter 2017, and elective capacity generally has reduced over time. There was clear seasonality in provision of elective surgery, with less complex patients admitted during winter.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Declining elective capacity and seasonality has a marked effect on the provision of joint replacement, despite efficiency improvements in hospital treatment. The Trust has outsourced less complex patients to independent providers, and\/or treated them during winter when capacity is most limited. There is a need to explore whether these are strategies that could be used explicitly to maximise the use of limited elective capacity, provide benefit to patients and value for money for taxpayers.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2022-066398","type":"journal-article","created":{"date-parts":[[2023,5,16]],"date-time":"2023-05-16T10:04:28Z","timestamp":1684231468000},"page":"e066398","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":5,"title":["Impact of pausing elective hip and knee replacement surgery during winter 2017 on subsequent service provision at a major NHS Trust: a descriptive observational study using interrupted time series"],"prefix":"10.1136","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1199-8668","authenticated-orcid":false,"given":"Tim","family":"Jones","sequence":"first","affiliation":[{"name":"NIHR ARC West, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK"},{"name":"Musculoskeletal Research Unit, University of Bristol, Bristol, UK"},{"name":"Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8654-353X","authenticated-orcid":false,"given":"Chris","family":"Penfold","sequence":"additional","affiliation":[{"name":"NIHR ARC West, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK"},{"name":"Musculoskeletal Research Unit, University of Bristol, Bristol, UK"},{"name":"Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maria Theresa","family":"Redaniel","sequence":"additional","affiliation":[{"name":"NIHR ARC West, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK"},{"name":"Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2695-7172","authenticated-orcid":false,"given":"Emily","family":"Eyles","sequence":"additional","affiliation":[{"name":"NIHR ARC West, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK"},{"name":"Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tim","family":"Keen","sequence":"additional","affiliation":[{"name":"North Bristol NHS Trust, Westbury on Trym, Bristol, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrew","family":"Elliott","sequence":"additional","affiliation":[{"name":"North Bristol NHS Trust, Westbury on Trym, Bristol, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9940-1095","authenticated-orcid":false,"given":"Ashley W","family":"Blom","sequence":"additional","affiliation":[{"name":"Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3015-0432","authenticated-orcid":false,"given":"Andrew","family":"Judge","sequence":"additional","affiliation":[{"name":"Musculoskeletal Research Unit, University of Bristol, Bristol, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2023,5,16]]},"reference":[{"key":"2025121509054811000_13.5.e066398.1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(11)60752-6"},{"key":"2025121509054811000_13.5.e066398.2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(12)60607-2"},{"key":"2025121509054811000_13.5.e066398.3","first-page":"32344","article-title":"Hip and knee replacement 2 knee replacement","volume":"392","author":"Price","year":"2018","journal-title":"Lancet"},{"key":"2025121509054811000_13.5.e066398.4","doi-asserted-by":"crossref","first-page":"1662","DOI":"10.1016\/S0140-6736(18)31777-X","article-title":"Hip replacement","volume":"392","author":"Ferguson","year":"2018","journal-title":"Lancet"},{"key":"2025121509054811000_13.5.e066398.5","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.J.00234"},{"key":"2025121509054811000_13.5.e066398.6","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2017-019146","article-title":"Trends and determinants of length of stay and hospital reimbursement following knee and hip replacement: evidence from linked primary care and NHS Hospital records from 1997 to 2014","volume":"8","author":"Burn","year":"2018","journal-title":"BMJ Open"},{"key":"2025121509054811000_13.5.e066398.7","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(13)61003-X"},{"key":"2025121509054811000_13.5.e066398.8","unstructured":"Briggs T . 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