# Are We Truly Addressing the Elective Surgery Backlog?

## TL;DR

This study shows that coding errors in hospital records are making orthopaedic surgery waiting times appear shorter than they really are.

## Contribution

The study quantifies how misclassifying acute cases as elective surgery artificially reduces reported waiting times in orthopaedics.

## Key findings

- 44 out of 381 elective-coded cases were actually acute surgeries.
- False elective cases had a 10.86-day wait vs. 247.24 days for true elective cases.
- Incorrect coding reduced the mean waiting time by 27.14 days (11.01%).

## Abstract

Background

Orthopaedics currently has the largest waiting list of any surgical speciality in the UK, and the number of patients awaiting elective surgery is continuing to climb. This retrospective study aims to quantify the impact of coding errors on elective surgery waiting times at a large UK district general hospital.

Method

Data from 381 patients who underwent operations on elective orthopaedic operating lists between January 1, 2025, and March 31, 2025, were included in the study. Most orthopaedic patients with acute issues are operated on a dedicated acute list. However, surges in acute referrals may result in re-purposing of elective operating lists to treat acute patients. These cases are at risk of being incorrectly coded as elective operations. The electronic booking code of the operation was compared with the case notes of each patient to determine if the coding as elective or acute was accurate.

Results

Of the 381 patients coded as elective, 44 were acute cases falsely coded as elective. The mean waiting time for these false elective cases was 10.86 days, in comparison to 247.24 days for the true elective cases. Overall, incorrect coding of trauma cases as elective cases artificially reduced the mean waiting time by 27.14 days, or 11.01%. A Mann-Whitney U test showed this to be statistically significant (p = 0.012).

Conclusion

Inaccurate electronic coding substantially and artificially reduces orthopaedic surgery waiting time. This is likely driven by human error and software errors that can prevent correct coding. These issues might be addressed through a review of the approved Electronic Patient Record (EPR) software systems, staff training, and a further push towards cold-site operating to better separate acute and elective orthopaedic care. Finally, a multi-centre study would demonstrate how far-reaching these coding errors are.