{
  "abstract": "Objectives: To examine whether longer waits for hip and knee replacement were associated with higher post-operative patient dissatisfaction and smaller patient-reported functional improvement, and whether worse post-operative satisfaction was associated with smaller functional improvement, in National Health Service (NHS) care in England. Design: Retrospective observational study linking respondent-level Patient Reported Outcome Measures (PROMs) to provider-year Referral to Treatment (RTT) waiting times, with a supplementary comparison of the wait-dissatisfaction relationship in general practice. Setting: NHS-funded hip and knee replacement in England, 2017, 2018, 2022 and 2023, excluding the pandemic-affected years 2019-2021. Participants: 107,700 hip and 122,756 knee replacement PROMs respondents, and all 42 Integrated Care Boards (168 ICB-year observations) for the general practice comparison. Primary and Secondary Outcome Measures: Post-operative dissatisfaction (fair or poor on a five-point satisfaction scale) and Oxford Score improvement (post-operative minus pre-operative score). Secondary outcomes were EQ-5D improvement and the full five-category satisfaction score. Results: Each additional 30 days of average wait was associated with a 0.05 increase in the log-odds of post-operative dissatisfaction for hip (95% CI 0.03 to 0.08) and 0.04 for knee (0.03 to 0.06), and with smaller Oxford Score improvement (hip -0.26 points, -0.44 to -0.08; knee -0.11 points, -0.22 to -0.01). Mean Oxford Score improvement fell monotonically across satisfaction categories, from 26.11 points (hip) and 22.74 points (knee) among patients reporting excellent satisfaction to 2.62 and -0.01 points among those reporting poor satisfaction. In general practice, the wait-dissatisfaction association was close to zero but too imprecise to rule out an association of the size seen for hip and knee replacement. Conclusions: In this focused surgical pathway, waiting times, post-operative satisfaction and patient-reported recovery were consistently associated, and satisfaction carried information about patient-reported recovery, not only about the experience of care. Performance frameworks that apply a common satisfaction measure across care settings should not assume it carries the same outcome content in each.",
  "abstract_shown": true,
  "affiliations": [
    "Ellison Institute of Technology"
  ],
  "article_type": "PUBLISHAHEADOFPRINT",
  "arxiv": null,
  "author_total": 2,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "R. Joseph"
    },
    {
      "name": "S. Danielli"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/fg4b7krvdwkw5.bib",
  "cited_by": 0,
  "doi": "10.64898/2026.10.28.26366729",
  "fulltext_url": "https://www.medrxiv.org/content/10.64898/2026.10.28.26366729v1.full",
  "id": "fg4b7krvdwkw5",
  "issns": [],
  "landing_url": "https://www.medrxiv.org/content/10.64898/2026.10.28.26366729v1",
  "language": null,
  "licence": "CC-BY",
  "licence_label": "CC BY",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "medrxiv",
      "health systems and quality improvement"
    ]
  ],
  "openalex": null,
  "pdf_url": "https://www.medrxiv.org/content/10.64898/2026.10.28.26366729v1.full.pdf",
  "pmcid": null,
  "pmid": null,
  "published": "2026-10-28",
  "publisher": null,
  "ris": "https://research.draconitic.com/paper/fg4b7krvdwkw5.ris",
  "sources": [
    {
      "first_seen": "2026-10-31T00:20:43Z",
      "native_id": "10.64898/2026.10.28.26366729",
      "source": "medrxiv",
      "url": "https://www.medrxiv.org/content/10.64898/2026.10.28.26366729v1"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "medrxiv:health systems and quality improvement",
      "subfield": "epidemiology-public-health"
    }
  ],
  "title": "Are Longer Waits Associated with Lower Satisfaction and Worse Recovery? A Retrospective Observational Study of Hip and Knee Replacement in England",
  "title_text": "Are Longer Waits Associated with Lower Satisfaction and Worse Recovery? A Retrospective Observational Study of Hip and Knee Replacement in England",
  "type": "preprint",
  "updated_at": "2026-11-01T00:20:31Z",
  "url": "https://research.draconitic.com/paper/fg4b7krvdwkw5",
  "venue": "medRxiv",
  "versions": []
}