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RTÉ News
23-05-2025
- Health
- RTÉ News
Questions from hip audit to take many months to answer
The questions raised by the independent audit of children's hip surgeries will take many months, perhaps even longer, to answer. It will bring a period of great worry for parents and young children waiting to see if they are part of the patients where it was deemed surgery was not indicated. The issue first emerged after concerns were raised with Children's Health Ireland by a whistleblower about the thresholds being applied when making the decision to undertake surgery for children with Developmental Hip Dysplasia (DHD). Around 1,800 children and young adults will be offered a review and some of these are already under way. However, the process is expected to take around six months and will use external experts. One of the major findings from the audit is that the percentages of pelvic osteotomies not reaching the criteria at Temple Street and Cappagh are so high that it mandates further inquiry. The audit author, UK paediatric orthopaedic surgeon Mr Simon Thomas, also found that while there is worldwide variability between surgeons, the variance identified here cannot be accounted for by measurement error or observer variability alone. Asked about this on RTÉ Radio today, Dr Colm Henry, the Chief Clinical Officer, said the surgeons believed the interventions were necessary and had evolved based on research. Bernard Gloster, the HSE Chief Executive, described the variance as being of very serious concern and said measures will be taken to ensure this kind of variation cannot recur. Minister for Health Jennifer Carroll MacNeill said she is moving now to strengthen governance and oversight structures at Children's Health Ireland and Cappagh. She said this will be done with the appointment of two members of the HSE Board to the Board of CHI. Lawyers representing some of the families said the report makes for difficult reading and that the percentage of affected children is very high. They want speedy access to orthopaedic surgeon reviews and to establish what remedies are needed.
The Journal
23-05-2025
- Health
- The Journal
Many surgeries on children's hips in two hospitals did not meet criteria for operating
HSE LEADERSHIP HAS confirmed that the surgeons who performed hip surgeries on children that did not meet the criteria for operating are still carrying out these operations, with no disciplinary process being pursued at this time. Dr Colm Henry, HSE Chief Clinical Officer, told media in a technical briefing today that the surgeons who carried out the cohort of surgeries that an independent expert found to be unwarranted. It comes as an independent audit into children's hip surgeries in Irish hospitals has called for an open inquiry into operations that were carried out at Temple Street and Cappagh Hospital, where the criteria for operating wasn't met in a high number of cases. The audit found that a lower threshold was used by surgeons in Temple Street and Cappagh Hospital in deciding when to operate on children, though this issue wasn't identified in CHI Crumlin which was also examined in the audit. The independent expert found that in Temple Street roughly 40% of the surgeries the audit reviewed were indicated under his criteria, in Cappagh 21% were indicated, and in Crumlin virtually all of the surgeries fell under the criteria. The CEO of the HSE Bernard Gloster said that the variance in surgical practice that was detected is 'of very serious concern'. He said that the HSE will now establish an 'expert panel' to respond to parents and families in relation to their individual procedures 'and whether they were necessary'. Dr Henry said that CHI and the HSE are focused on 'cutting off the source of the variation' in the decision making process behind children's surgeries, and that going forward by establishing a new pathway. 'That will ensure that anyone who may have been applying a low threshold before has to go through a peer review of surgeons in order to progress the surgery,' he said. He said that it is 'leaping ahead' to talk about disciplinary action for surgeons who applied a low threshold for surgery until the follow up appointments with children who have been impacted, in order to assess whether any complications have arisen as a result. Though the audit did identify one child who was adversely impacted by an operation that would not have fallen under the criteria used in the audit, that child 'didn't require surgery' as a result of the complication, Dr Henry said. Dr Henry said there is variation in practices around the world when it comes to the decision-making processes behind surgeries, but that this audit has found that the variance in the two hospitals was 'at the higher end' of variance, which is 'concerning'. Around 1,800 children who have undergone these operations in the two hospitals will now be offered a follow up appointment with a multidisciplinary team to assess whether the surgery has had any adverse impact on them, and to give them the chance to find out if their surgery was necessary. Advertisement Dr Henry said that the plan is to offer these follow up appointments over a six month period. He further said that this will only be offered to those who have not yet reached skeletal maturity, but that the HSE is aware of those within the cohort who will be nearing skeletal maturity soon, and that they will be prioritised. Dr Henry acknowledged that decision-making across the three hospitals has not been done in a joint way, and that this audit have undermined the public's confidence in the clinical processes of CHI, which is of real concern in advance of the opening of the New Children's Hospital. However, he added that having all of the teams in the same place 'geographically' will enable closer collaboration, and that all decision-making on this type of procedure will now be done under a new framework, overseen by two surgical experts. The audit identified that there was no informed consent from parents or families when a novel surgical technique was used on some of the children who were operated on. The review, carried out by Simon Thomas, a UK consultant paediatric orthopaedic surgeon, looked at the clinical records and X-rays pertaining to children aged 1-7 who were operated on between January 2021 and December 2023. Ten cases of each surgeon who was operating at that time in the Crumlin, Temple Street, and Cappagh Children's Health Ireland hospitals were examined as part of the review, amounting to 147 cases in total. The surgeons were anonymised for the purposes of the audit, as were the children whose cases were examined. The review found that in many cases, children underwent major pelvic osteotomy surgery though they had not been treated for persistent hip dysplasia after bracing and hip reduction failed to work. There were many cases of children being operated on who had no prior history of diagnosis of developmental dysplasia of the hip. At the outset of the audit, the reviewing surgeon notes: 'It would be unusual for corrective pelvic osteotomy in childhood to be indicated in large numbers of essentially untreated hips.' Dr Henry said at the technical briefing today that predicting the likelihood of persistent DDH (developmental dysplasia of the hip) later in life is 'never 100%', and that parents are informed of that. In an official statement the HSE welcomed the publication of the audit. ' We acknowledge and deeply regret the anxiety that the audit, and the time taken before publication, has caused to children and their families,' a spokesperson said. 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