“It’s a very serious situation, very, very serious, and I’m very concerned about it.” Those are the words of Taoiseach Micheál Martin following the publication of an audit that found almost 70 per cent of surgeries for developmental dysplasia of the hip (DDH) in two Dublin hospitals were unnecessary.
The report, which Opposition politicians have described as “distressing”, highlighted variation in the thresholds for surgeries carried out between 2021 and 2023 across three hospitals: Temple Street, Crumlin and National Orthopaedic Hospital Cappagh (NOHC)
According to the findings of the audit, published on Friday, 85 hip 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.
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Only one of the 63 surgeries examined at Crumlin hospital did not meet the clinical criteria, with this hospital largely keeping in line with international criteria for surgical intervention.
Furthermore, the audit also highlighted how a “novel technique” was used in Temple Street and Cappagh, though the HSE said the issue had less to do with this technique and was more about the threshold for surgery.
But the real question for many people, particularly affected families, is how did this happen?
Dr Colm Henry, chief clinical officer of the HSE, said this type of surgery – pelvic osteotomy – is about early intervention and it’s a “risk/benefit analysis all the time”.
“The purpose of this is to prevent more difficult surgery later on, with less predictable outcome. Surgeons make judgements all the time on whether surgical intervention is beneficial or necessary,” he said.
“It is always accepted in all units in making that assessment and following it through to surgery eventually, there will be some procedures which will be unnecessary.”
But the key question that emerged following the publication of the report is why exactly was the variation so significant between Crumlin and the other two hospitals.
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.
However, he adds the difference identified between Crumlin hospital and the other two “cannot be accounted for by measurement error or observer variability alone”. Consequently, he says, there is a need for “further inquiry” into this.
Does this mean harm has been done? That remains to be seen. The audit identified one patient who experienced an “adverse outcome” from the operation, though this was transitory.
But the potential risk of harm is why the HSE is following up with all patients going back to 2010. Dr Henry said they want to see “what was the outcome and did it result in harm?”.
In terms of what’s next, the HSE and CHI have set out a clear picture. All children who underwent surgery from 2010 – almost 2,200 children – will be offered follow-up clinics. Those who are reaching “skeletal maturity” will be prioritised.
There will also be a panel of experts who will “try their best to determine” whether the surgery was indicated, if parents or families seek answers in relation to this.
Changes have already been made in terms of how these surgeries are carried out. The HSE confirmed it had enacted the recommendation to ensure there is peer-review across the three sites before such a procedure is conducted.
For families, there are just as many questions as answers following the report’s publication. Such as: if this audit looked only at three years of patients, just how many more patients could be affected?
