Unadjusted and adjusted factors associated with prolonged surgical wait times for knee and hip arthroplasty*†
| Patient characteristic | Knee arthroplasty | Hip arthroplasty | ||
|---|---|---|---|---|
| OR (95% CI) | Adjusted OR‡ (95% CI) | OR (95% CI) | Adjusted OR‡ (95% CI) | |
| Age, yr (ref. 40) | ||||
| 50 | 1.14 (1.09–1.19) | 1.17 (1.12–1.23) | 0.86 (0.82–0.90) | 0.89 (0.84–0.94) |
| 60 | 1.21 (1.12–1.30) | 1.27 (1.18–1.37) | 0.74 (0.68–0.80) | 0.78 (0.72–0.85) |
| 70 | 1.19 (1.10–1.29) | 1.28 (1.17–1.39) | 0.69 (0.64–0.75) | 0.75 (0.69–0.81) |
| 80 | 1.10 (1.02–1.19) | 1.18 (1.09–1.28) | 0.66 (0.61–0.71) | 0.71 (0.66–0.77) |
| Comorbidity score (per 5-unit increase)§ | 0.92 (0.91–0.94) | 0.93 (0.91–0.94) | 0.88 (0.86–0.90) | 0.90 (0.88–0.92) |
| Priority level (ref. (4))¶ | ||||
| Priority | 3 2.57 (2.50–2.65) | 3.10 (3.01–3.20) | 2.54 (2.45–2.64) | 3.01 (2.89–3.13) |
| Sex (ref. male) | ||||
| Female | 1.06 (1.03–1.08) | 1.08 (1.06–1.11) | 0.96 (0.93–0.99) | 0.99 (0.95–1.02) |
| Rural (ref. non-rural)** | 1.15 (1.10–1.20) | 0.89 (0.85–0.93) | 1.23 (1.17–1.30) | 0.96 (0.91–1.02) |
| Region (ref. Toronto) | ||||
| Eastern | 1.48 (1.39–1.57) | 1.87 (1.75–2.00) | 1.68 (1.55–1.81) | 1.82 (1.68–1.98) |
| GTHA | 2.08 (1.96–2.19) | 2.43 (2.29–2.57) | 1.82 (1.70–1.95) | 2.03 (1.89–2.19) |
| Western | 4.87 (4.60–5.15) | 6.53 (6.12–6.97) | 4.14 (3.86–4.43) | 4.71 (4.35–5.10) |
| Northern | 2.40 (2.24–2.57) | 2.67 (2.47–2.88) | 2.05 (1.89–2.23) | 1.77 (1.60–1.96) |
| Hospital type (ref. non-teaching)†† | ||||
| Teaching | 1.05 (1.01–1.08) | 1.33 (1.29–1.37) | 1.35 (1.30–1.40) | 1.66 (1.60–1.73) |
| Year (ref. 2013) | ||||
| 2014 | 0.89 (0.85–0.94) | 0.90 (0.85–0.95) | 0.88 (0.82–0.94) | 0.89 (0.83–0.96) |
| 2015 | 0.86 (0.82–0.91) | 0.93 (0.89–0.99) | 0.94 (0.88–1.01) | 1.02 (0.95–1.10) |
| 2016 | 1.08 (1.03–1.13) | 1.21 (1.15–1.27) | 1.04 (0.97–1.11) | 1.17 (1.09–1.26) |
| 2017 | 1.19 (1.13–1.25) | 1.42 (1.35–1.49) | 1.11 (1.03–1.18) | 1.35 (1.26–1.45) |
| 2018 | 1.14 (1.09–1.20) | 1.36 (1.29–1.44) | 1.00 (0.93–1.06) | 1.22 (1.14–1.31) |
| 2019 | 1.04 (0.99–1.09) | 1.26 (1.19–1.32) | 1.00 (0.93–1.06) | 1.23 (1.15–1.32) |
| Dependency quintile | ||||
| 2 | 1.00 (0.95–1.05) | 1.03 (0.98–1.08) | 1.06 (0.99–1.13) | 1.06 (0.99–1.13) |
| 3 | 1.00 (0.95–1.05) | 1.05 (0.99–1.10) | 1.00 (0.94–1.07) | 1.01 (0.94–1.07) |
| 4 | 0.99 (0.95–1.05) | 1.04 (0.99–1.10) | 1.00 (0.94–1.06) | 1.02 (0.95–1.09) |
| 5 | 0.97 (0.92–1.01) | 1.03 (0.98–1.09) | 0.96 (0.91–1.02) | 0.98 (0.92–1.05) |
| Deprivation quintile | ||||
| 2 | 1.01 (0.97–1.06) | 1.01 (0.97–1.06) | 1.02 (0.97–1.08) | 1.04 (0.99–1.10) |
| 3 | 1.12 (1.07–1.17) | 1.12 (1.07–1.17) | 1.07 (1.01–1.13) | 1.10 (1.03–1.16) |
| 4 | 1.15 (1.10–1.21) | 1.17 (1.11–1.22) | 1.12 (1.06–1.18) | 1.17 (1.10–1.25) |
| 5 | 1.16 (1.10–1.21) | 1.18 (1.12–1.24) | 1.13 (1.06–1.20) | 1.20 (1.12–1.28) |
| Instability quintile | ||||
| 2 | 0.98 (0.94–1.03) | 1.01 (0.97–1.06) | 1.06 (0.99–1.12) | 1.08 (1.01–1.15) |
| 3 | 1.00 (0.96–1.05) | 1.01 (0.96–1.06) | 1.05 (0.99–1.11) | 1.05 (0.99–1.12) |
| 4 | 1.00 (0.96–1.05) | 0.98 (0.93–1.03) | 1.05 (0.99–1.11) | 1.03 (0.96–1.10) |
| 5 | 1.06 (1.00–1.11) | 0.97 (0.92–1.03) | 1.11 (1.04–1.18) | 1.05 (0.98–1.13) |
| Visible minority quintile | ||||
| 2 | 0.98 (0.94–1.02) | 0.97 (0.93–1.01) | 0.95 (0.90–1.00) | 0.95 (0.90–1.00) |
| 3 | 1.00 (0.95–1.05) | 0.95 (0.90–1.00) | 0.98 (0.93–1.04) | 0.94 (0.88–1.00) |
| 4 | 1.07 (1.01–1.13) | 0.96 (0.90–1.02) | 0.97 (0.91–1.03) | 0.88 (0.81–0.95) |
| 5 | 1.28 (1.20–1.36) | 1.05 (0.97–1.13) | 0.93 (0.86–1.01) | 0.82 (0.75–0.91) |
| Recent immigration | ||||
| 2 | 1.06 (1.02–1.11) | 1.02 (0.97–1.06) | 1.02 (0.97–1.07) | 1.00 (0.95–1.06) |
| 3 | 1.25 (1.20–1.31) | 1.09 (1.03–1.16) | 1.03 (0.97–1.10) | 1.02 (0.95–1.10) |
Note: CI = confidence interval, GTHA = Greater Toronto and Hamilton Area, OR = odds ratio.
↵* Unless otherwise stated, the reference group for presented odds ratios is quintile 1.
↵† Levels of marginalization was categorized by ranking all dissemination areas in Ontario within each domain (or sub-domain) and assigned to a quintile, with quintile 1 representing the dissemination area with the lowest marginalization and quintile 5 (or quintile 3 in the case of “immigrated last 5 years”) the highest.
↵‡ Adjusted odds ratios were calculated by adjusting for all the variables in the table.
↵§ Comorbidity score category: Sum of Aggregated Diagnosis Groups (ADGs). Estimated using ADGs calculated with The Johns Hopkins ACG System Version 10 software, based on subjects’ health care utilization records in the Discharge Abstract Database, Same-Day Surgery Database, and Ontario Health Insurance Plan database.
↵¶ The Wait Time Information System classifies procedure priority level. Level 1 is the most urgent, requiring immediate transfer to the operating room. This is followed by levels 2, 3 and 4, requiring urgent, semi-urgent and elective surgical intervention. The target wait time for level 3 is 84 days or fewer, and for level 4, 182 days or fewer.
↵** Rural residence includes residences in all territories lying outside population centres with > 10 000 residents. Regions defined as per Canada Post Corporation.
↵†† Teaching status: teaching hospitals are those classified as Group A under the Public Hospitals Act. (13)