Ireland’s aging population will increase the future demand for elective hip replacements, according to a study led by RCSI.

The study shows that in the next 20 years, the demand for hip replacements will increase and could result in €33 million in additional cost to the health service.

Undertaken by the Healthcare Outcomes Research Centre (HORC) at RCSI, the study is published in the journal Public Health. It analysed seven years of historical data obtained from the Irish Central Statistics Office (CSO), and the National Hospital Inpatient Enquiry system from 2011-2017 on elective hospital patient discharges with primary unilateral hip replacements.

Elective hip replacement is a common procedure for elderly people with osteoarthrosis and the demand for elective hip replacements has increased from 2,730 procedures in 2011 to 3,624 procedures in 2017.

In contrast, the average length of stay for patients undergoing elective hip replacements in public hospitals has decreased from 7.8 days in 2011 to 5.4 days in 2017.

Using data from the National Health Pricing Office, the study projects the expected number of elective hip replacements and expected patient bed days up to 2046, and the potential future cost of the procedure to the Irish health service.

Four potential scenarios were identified:

• The first scenario examines the consequences of population expansion assuming that procedure rates and average lengths of stay remain unchanged at the 2017 level. In this scenario, the Irish health service could face up to €16m (+33%) in extra costs by 2026, rising to €72m by 2046.
• The second scenario assumes an annual increase of 2.3% in procedure rates with length of patient stay remaining constant. In this case, costs to the Irish health service would increase by €33m (+66%) in 2026 and by almost €90m in 2046.
• In the third scenario, assuming that average length of stay continues to decrease by 6% until 2026 and remains unchanged following that, the 2026 cost is estimated to reduce from the 2017-level by €14m (-29%) and by 2046 the additional costs will have risen to just €3m.
• The fourth scenario takes both the increases in procedure rates and the decrease in lengths of stay up to 2026 into account and the 2026 cost was estimated to reduce from the 2017-level by €5m (-9.7%) and to increase by €16m in 2046.

Musculoskeletal conditions, such as osteoarthritis or osteoporosis, are ranked among the most prevalent and costly chronic conditions associated with aging. In 2014, the Health Information and Quality Authority (HIQA) reported that osteoarthritis was the primary cause of 92% of hip replacements in Ireland.

Commenting on the study, Jan Sorensen, Director of the Healthcare Outcomes Research Centre and study co-author, said: “When it comes to the delivery of elective hip replacements, Ireland’s hospital services are under strain, with the results of this study indicating a significant future increase in numbers of people requiring the procedure.

“The average patient length of stay is decreasing, which is positive to see, but this needs to continue in order to cater to increasing numbers. We could learn a lot from our international peers, many of whom have introduced enhanced recovery programmes into hip replacement programmes, ensuring that patients are active participants in the rehabilitation process and that the best standard of multidisciplinary collaboration is provided throughout. These programmes have shown to be particularly appropriate for older patients, reducing the length of their hospital stay significantly.

“Data-driven decision-making in health policy is vital. We will continue to develop and disseminate evidence-based research on healthcare outcomes to inform policy and improve patient outcomes through the Healthcare Outcomes Research Centre at RCSI.”