Cancelling knee replacement surgeries is “unforgivable”, academics have said, as a new study highlighted how postponing operations is costing the NHS millions and increasing hospital waiting lists.
As well as the economic cost, cancelled procedures come at a “great cost” to patients, researchers from the University of Bristol said.
A former Bristol Rovers captain described how his operation was cancelled at the “11th hour” while he sat waiting in his hospital gown.
It comes as a new study examined cancellations across six NHS hospitals in England, Scotland, Wales and Northern Ireland, over five years between April 2018 and March 2023.
During this period 17,223 total knee replacement operations were completed and 9,403 were cancelled.
A quarter (25%) of the cancellations were less than 24 hours before surgery, and 60% were within two to 14 days, researchers wrote in The Bone & Joint Journal.
The research team, led by academics at the National Institute for Health and Care Research Bristol Biomedical Research Centre, pointed out that each operation cancelled at short notice costs the NHS a “lost tariff” of between £6,500 and £11,000.
“The loss of a minimum £6,500 per case in the five-year period across six hospitals adds up to over £15.5 million, or approximately £518,000 per hospital per year,” they said.
They said that more than 110,000 total knee replacements are performed yearly in the UK.
Meanwhile they point out that cancellations “affects the length of NHS waiting lists”.
They added: “Preventing avoidable cancellations is one step that can be taken to tackle the waiting list.”
Former Bristol Rovers player Peter Aitken, 71, was a patient and public contributor for the research.
He said: “My knee replacement operation was originally booked for November 2023, but was cancelled after my pre-op appointment because of blood-thinning medication I was taking at the time.
“It was rescheduled for March 2025, and I attended hospital on the day.
“But, after a wait of seven-and-a-half hours, when I was ready with my gown on, I was told at the 11th hour that the operation would have to be cancelled because they ran out of time.”
Study author Dr Mark Eveleigh, consultant anaesthetist at Gloucestershire Hospitals NHS Foundation Trust, said: “Cancelled operations aren’t just about wasted resources – each cancellation statistic represents a patient who has often uprooted their entire life to get into hospital, followed the preparation advice to the letter, arranged transport and found someone to look after loved ones, frequently at great cost to themselves.
“So for us then not to do the operation after they have gone through all that is, in my mind, unforgivable.
“We should strive for zero avoidable cancellations, and projects like this are the first step to realising that across the NHS.”
Michael Whitehouse, professor of trauma and orthopaedics at the University of Bristol, and a co-author on the paper, added: “This work has demonstrated a substantial and underappreciated problem for the large number of patients waiting for joint replacement surgery.”
Dr Wendy Bertram, study lead and senior research associate in musculoskeletal health services research at the University of Bristol, added: “This study shows knee replacement operations are cancelled much more often than we thought.
“There are a lot of statistics in our publication – each and every one represents a human being who has been waiting a long time for a procedure to relieve their pain. Many people wait a year or more, and endure a life put on hold, not able to make plans or do the things they enjoy.
“The light at the end of the tunnel is their operation, but cancellation quickly snuffs this out.
“We can do better for these people, so we are using the information from this study to build programmes that will prevent cancellation and support people while they wait.”
An NHS spokesperson said: “The number of knee replacements being carried out has risen since the period of this study by nearly a third, with the NHS opening 123 surgical hubs with dedicated beds and staffing to carry out more procedures, cut waiting times for patients and drive efficiencies.
“But we recognise there is further to go to prevent cancellations, which we know are very frustrating for patients and families. NHS teams are taking further steps including ensuring patients are fit for surgery by offering personalised support to help lose weight, stop smoking and manage their mental health as well as by getting patients home on the same day as their operation which frees up beds.”
