Does exceeding maximum waiting times of total hip replacement patients affect resource consumption? Evidence from a highly specialized orthopedic Italian hospital.

BACKGROUND: Long waiting times for elective surgeries are a common issue in publicly funded healthcare systems, raising concerns about their impact on patient outcomes. In Italy, the National Health System assigns priority classes to regulate waiting times, with class C patients expected to undergo surgery within 180 days. This study investigates whether exceeding this threshold affects surgical and hospitalization outcomes for patients undergoing total hip replacement (THR). METHODS: We conducted a retrospective observational study on 1,872 class C patients who underwent THR between 2019 and 2022 at the Rizzoli Orthopedic Institute and affiliated centers. Patients were categorized based on adherence to the 180-day waiting threshold. The study analyzed differences in surgical time, length of hospital stays and touch time. Additional analyses considered patient characteristics such as the American Society of Anesthesiologists (ASA) classification and Body Mass Index (BMI). Independent t-tests were used to assess statistical significance. RESULTS: Patients exceeding the 180-day waiting limit did not show significantly longer hospital stays or surgical times compared to those operated on time (p>0.05). However, ASA classification and BMI influenced hospital stay duration, with high ASA (3-4) patients staying 1.7 days longer on average and obese patients (BMI ≥30) staying 0.4 days longer. CONCLUSIONS: The findings suggest that exceeding the maximum waiting time does not negatively impact surgical outcomes or hospital stay duration. However, clinical characteristics such as ASA and BMI play a significant role in postoperative recovery. Further research is needed to refine prioritization criteria to ensure optimal patient outcomes.