HomeLifestyleHip surgery waiting times to be reduced under new national guidelines
Hip surgery waiting times to be reduced under new national guidelines
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Hospital operating theatres will need to make space for an increase in hip surgeries as Australia’s population ages, with new guidelines recommending faster turnarounds to improve recovery outcomes.
The Australian Commission on Safety and Quality in Health Care’s new national clinical care standard for hip fracture, to be released on Monday, will shorten the recommended maximum time to surgery following the injury from 48 hours to 36 hours.
Jebby Phillips says her hip fracture last year was a blow to her confidence. Credit: Eddie Jim
For the first time, the standard’s time target will include patients who are transferred to a new hospital for surgery, a common practice in regional areas.
Every year, 19,000 Australians fracture their hip, usually after a fall. Most patients are aged over 65 and longer wait times for surgery both increase their risk of complications – such as pressure injuries, infections and delirium – and impede recovery. Every additional day the operation is delayed typically adds two days to a patient’s hospital stay.
The Australian and New Zealand Hip Fracture Registry’s 2022 annual report, also being released on Monday, found 78 per cent of patients across 97 participating hospitals had surgery within 48 hours, although some waited as long as 92 hours.
Associate Professor Catherine McDougall, an orthopaedic surgeon at The Prince Charles Hospital in Brisbane and co-chair of the registry, said the annual dataset showed there had been significant reductions in people waiting extremely long periods, although there had been very little improvement in the average time to surgery.
In most states, theatre availability is the top reason for a delay of more than 48 hours, the annual report shows.
“The key changes that are required are at systems level,” McDougall said. “What that means really is priority allocation of hip patients within the emergency theatre complex.”
In its first update since 2016, the guidelines for treating hip fractures will now include requirements to assess and manage a patient’s nutrition and frailty, as well as to monitor for symptoms of delirium.
Delirium is a sudden change in a person’s cognitive abilities, usually characterised by confusion. The condition often follows changes in an older person’s health, such as an infection or being placed on new medication (painkillers), and is a major risk factor for dementia.
An analysis of registry data published last November found 39 per cent of hip fracture patients who underwent a cognitive assessment were diagnosed with delirium. However, with one in four patients not assessed before surgery, there is concern the condition is being left undiagnosed.
“We know that pain is a driver for delirium and hip fracture is a painful injury,” said Professor Jacqueline Close, a geriatrician at Sydney’s Prince of Wales Hospital and co-chair of the expert working group which developed the new clinical care standard.
“The best way to fix the pain is surgery,” she added.
Acting chief medical officer for the commission Associate Professor Carolyn Hullick said the new time targets for surgery would bring Australia in line with international standards; a priority given the nation’s ageing population.
“The older you are, the more at risk you are from this type of life-changing fracture,” she said, noting the surgery had good outcomes.
“People who have a hip fracture are in a significant amount of pain, so we even tend to operate on people even at the end of their life because it’s the right thing to do.”
Jebby Phillips, 78, was on her usual morning walk near her home in Turramurra, on Sydney’s north shore, last year when she fell after catching her foot in a pothole.
While her care in a private hospital was good – Phillips received surgery within two days and was up walking that afternoon – she said, as someone living alone, she felt she would have benefitted from a transfer to in-patient rehab, rather than being sent home three days after surgery.
The mental health impacts of a fall are also not adequately acknowledged during care, she said.
“My perception of myself has changed. Particularly when you’re an older woman, you expect a fall is the precipice of the edge, but it is important to know that this isn’t the case,” she said.
Three months after her fracture, Phillips went on an overseas trip to visit each of her sons. While she is now back to her daily walks, she said the fall had made her much more cautious when moving around.
“Let’s just say I am now the one reaching for the bannister when walking down the stairs at a movie theatre,” she said.
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