Hip surgery audit: Almost 70% of operations in two children's hospitals ‘unnecessary'
Furthermore, one child who received surgery for developmental dysplasia of the hip (DDH), despite not meeting the criteria for the procedure, experienced an 'adverse outcome' from the operation.
In July 2024,
Children's Health Ireland
(CHI) and the National Orthopaedic Hospital Cappagh (NOHC) announced a
joint clinical audit
to examine a random and anonymised sample of 147 DDH surgeries performed between 2021 and 2023.
The audit was prompted following a protected disclosure, which raised concerns that CHI at Crumlin, CHI at Temple Street and NOHC may have used differing criteria to determine whether DDH surgery was required.
READ MORE
According to the findings of the audit, published on Friday, 85 surgeries performed at Temple Street Hospital (TSH) were examined, of which 51 did not meet the clinical criteria for surgery - meaning 60 per cent were unnecessary.
In NOHC, 70 surgeries were audited, and 55 did not meet the criteria - meaning 79 per cent were unnecessary.
Only one of the 63 surgeries examined at Crumlin hospital did not meet the clinical criteria.
The clinical audit was conducted by Simon Thomas, a UK paediatric consultant orthopaedic surgeon. Children who were included in the audit were over the age of one but less than seven.
It examined 147 cases at the three hospitals, involving 14 surgeons.
In his report, the auditor notes that it 'is accepted that there is variation on the thresholds' at which different surgeons will recommend the surgery, called pelvic osteotomy.
However, he adds the variance identified between Crumlin hospital and the other two 'cannot be accounted for by measurement error or observer variability alone'.
The percentages of these procedures not reaching the criteria at Temple Street and NOHC being 'so high mandates further inquiry', the report said.
Mr Thomas said surgeons in Temple Street and Cappagh would 'benefit' from peer review across all three sites in relation to decision-making to agree and confirm reasonable clinical and radiological indications.
'This should be a routine part of surgical planning going forward,' he said. The HSE said this has been implemented.
The report also recommended that all 497 patients who underwent this surgery at Temple Street and NOHC between 2021 and 2023 should be recalled.
'They should undergo a standardised independent clinical review and radiological assessment. X-rays should then be reviewed, with the history obtained, by appropriately experienced paediatric orthopaedic surgeons from a different institution to NOHC or TSH,' the report said.
'Follow-up with a suitably experienced and independent paediatric orthopaedic surgeon may be required in some cases.'
Furthermore, the HSE confirmed a plan has been developed to ensure some 1,800 children and young people who have had the surgery in the two facilities since 2010 will be reviewed up to skeletal maturity.
Bernard Gloster, chief executive of the Health Service Executive (HSE) said there is 'little doubt' the findings of the audit 'raise significant concern'.
'Focus on follow up and putting in place a mechanism to ensure this kind of variation can't recur is central to our next steps, and we will be working with everyone to ensure that this can't happen again,' he said.
Lucy Nugent, chief executive of CHI, said the health group 'fully accepts the findings and recommendations from this audit'.
'I am sorry that impacted families were not offered one consistent and excellent standard of care across our DDH service,' she said.
'To one family in particular, whose child experienced complications during their care in Children's Health Ireland, I extend my heartfelt apology that we have let you down.'
Ms Nugent said they are 'standardising care' across all CHI sites so all children receive the same high-quality treatment.
'Also, it is important that we now act swiftly to review DDH surgery patients to enable us to answer outstanding questions raised by this audit. This will be done openly and transparently,' she added.
Angela Lee, chief executive of NOHC, apologised for the 'distress' the report may cause to children and parents.
Minister for Health Jennifer Carroll MacNeill said she 'immediately accepted the recommendations of the report and ensured that others did too'.
'Further to this, I have moved immediately to strengthen governance and oversight structures at CHI and NOHC,' she said. 'This will be done via the appointment of two members of the Health Service Executive Board to the Board of CHI.'
CHI and Cappagh Hospital have established a dedicated helpline for patients and families: 1800 807 050, or 00 353 1 240 8706 from outside Ireland. The phone line is open Monday to Friday 8am to 8pm and Saturday and Sunday 9am to 5pm.
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