Evaluation of explicit prioritisation for elective surgery: A prospective study

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Abstract
Objectives: To evaluate whether the Clinical Priority Assessment Criteria (CPAC), used to prioritise access to elective surgery, was associated with: (a) patients’ access to surgery in practice; (b) patients’ level of need; and (c) patients’ ability to benefit from surgery. Patients’ perceptions of the ‘booking system’ for surgery were also explored. Methods: Prospective cohort study in New Zealand. Consecutive patients assessed for cataract (n= 101), prostate (n=103) or hip or knee joint replacement (n=137) surgery were interviewed close to the time of their CPAC prioritisation, and then six and 12 months later. Results: CPAC scores were associated with access to surgery. There were weak-to-moderate correlations between CPAC scores and disease-specific health status before surgery (need) but almost no correlations with improvement in health status following surgery (ability to benefit). Change in health status was highly correlated with pre-surgery health status. Many patients supported prioritisation according to need, although the impersonal nature of the scoring system and the changing thresholds for surgery distressed some. Conclusions: While prioritisation systems for surgery have potential value the CPAC criteria investigated need modification. Ability to benefit should receive increased weight. The impact of an explicit prioritisation system upon the doctor-patient relationship needs to be explored as there is some evidence that it may impede the discussion of the risks and benefits of surgery, and of the treatment preferences of patients.