3 Apr 2016

Patients suffering because of surgery waits - surgeon

3:03 pm on 3 April 2016

Patients having non-urgent hip and knee replacement surgery are more severely disabled than before because they are being made to wait, a senior Dunedin surgeon says.

In an article in today's issue of the New Zealand Medical Journal, David Gwynne-Jones said a study of about 600 patients showed the demand for elective, or non-urgent, hip and knee replacements in 2013-2014 was higher than could be provided. A shortfall of 241 joint procedures.

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Demand for joint replacement surgery has soared. Photo: 123 RF

Mr Gwynne-Jones said unmet demand for the elective joint surgery in Otago had increased by 19 percent since 2012.

"Patients undergoing primary elective total hip and knee replacement in Otago in 2014 are more severely disabled than between 2006-2010. Patients currently being returned to a GP would have qualified for publicly-funded surgery during that period."

He also said that it had been predicted that the demand and projected numbers of hip and knee replacement would rise significantly, because of the ageing population.

"It is unclear how this can be funded. While the Budget announcement of increased numbers of total joint replacement from 2016 onwards is welcome, the numbers are inadequate to match demand."

The government introduced a target last year that DHBs only accept patients on the waiting list for operations if they could guarantee to provide that operation within four months.

Mr Gwynne-Jones said the target was artificial and by itself did nothing to increase capacity.

"The public needs to be given realistic expectations. There is explicit rationing and, although cost-effective, public funding for hip and knee replacement will soon only be for the most severely affected. Others need to consider private insurance or self-funding their surgery."

Orthopaedic Association president Jean-Claude-Theis, a professor of orthopaedic surgery at Dunedin Hospital, said the study's findings were correct.

He gave the example of an outpatient clinic at Dunstan Hospital in Otago he held where he saw 22 patients.

"Of those, 14 needed an orthopaedic operation, 10 of those required a hip or knee replacement and of those 10 only three would get their operation within 4 months, which is the government target."

He told RNZ News those patients had two options: either to pay to go privately "and of course very few have that opportunity", or to wait for their hip or knee to get worse.

Professor Theis also confirmed that those who were put on the waiting list for surgery were sicker than once was the case, and that posed problems for both patient and surgeon.

"Once the hip is completely destroyed the operation is more difficult, it takes longer, sometimes you have to use a different implant and overall it's actually more costly than if the operation had been done at the right time when the patient needed it."

He said it was frustrating for surgeons, because the operations were highly successful for patients, who often could live fuller more independent lives afterwards.

Arthritis New Zealand said the government needed to create a long-term strategy to deal with the rising number of people with arthritis.

Its chief executive Sandra Kirby said it could not see a long-term fix being worked on by the government, despite a growing number of people waiting in pain for surgery.

"We're one of the few Western countries that doesn't have a muscular skeletal or arthritis strategy. Australia has its 'Time to Move', Scotland looking at introducing that, the British have done it. We're unusual now in not having a long term approach to arthritis treatment.''

Ms Kirby said seven new pilot programmes would not meet the growing demand for services to reduce the disease's effects.

The head of orthopaedic surgery and musculoskeletal medicine at Otago University in Christchurch, Gary Hooper, also confirmed the conclusions of the Otago study. He said the government's four-month target had compounded problems of access to the surgery.

"The narrowing of the time band for the procedure to be completed, combined with the significant financial penalties placed on non-compliant DHBs, has resulted in rigid monitoring of the waiting list, with patients being 'dropped off' the list in order to remain compliant.

"Rather than give patients surety of care, this has created uncertainty with large numbers of patients not even making the threshold, when only four years ago they would have been offered surgery."

Health Minister Jonathan Coleman was not available to be interviewed.