Part of Australia’s response to the coronavirus pandemic was a severe reduction in elective surgery, and so private hospitals have stood almost empty for a month now.
People who might otherwise have had a procedure are experiencing “watchful waiting”, where their condition is monitored to assess how it develops rather than having a surgical procedure.
The big question is whether all those procedures which didn’t happen were even necessary. There has now been a steady stream of work which suggests many procedures don’t provide any benefits to patients at all – so called low- or no-value care.
Bringing about change in health policy is usually difficult (or slow, at best) because it’s like turning a big ship around. But in the past six weeks that ship has made a sudden about-turn.
Australia’s elective procedure system after the pandemic should be different from before the pandemic. We should dramatically reduce the number of low- or no-value procedures.
Research in New South Wales public hospitals showed up to 9,000 low-value operations were performed in just one year, and these consumed almost 30,000 hospital bed days that could have been used for high-value care.
One example of low-value care is spinal fusion surgery for low back pain. This is a procedure on the small bones in the spine, essentially welding them together. The alternative is pain management, physiotherapy and exercise.
The NSW analysis revealed up to 31% of all spinal fusions were inappropriate. But even this figure is likely an underestimate.
Other examples include:
- vertebroplasty for osteoporotic spinal fractures;
- knee arthroscopy for osteoarthritis;
- laparoscopic uterine nerve ablation for chronic pelvic pain;
- removing healthy ovaries during a hysterectomy;
- hyperbaric oxygen therapy for a range of conditions including osteomyelitis (inflammation of the bone), cancer, and non-diabetic wounds and ulcers.
Low-value care can harm patients because of the risks inherent in any procedure. If a patient having a low-value procedure gets even one complication, the time they spend in hospital doubles, on average.
For some patients, the hospital stay can be much longer. For example, a low-value knee arthroscopy with no complications consumes one bed day. If a complication occurs, that length of stay increases to 11 days, on average.
For most low-value procedures, the most common complication is infection.
The situation is even worse in private hospitals, where a much greater proportion of elective procedures are low value.
Prioritise treatments that work
Most state health departments and private insurers now know the size of the low-value care problem and which hospitals are providing that “care”.
Due to the COVID-19 response, the tap for these procedures has been turned down for some and off for others. This is a risk for some patients, but others will benefit from not having the surgery. We must grasp the opportunity to learn from this enforced break.