Audit finds major inconsistencies in hip surgery criteria across children's hospitals

Temple Street Children's University Hospital in Dublin. Picture: Sasko Lazarov/© RollingNews.ie

An audit of hip surgeries has found significant differences in the criteria used for children’s procedures at Temple Street Hospital and National Orthopaedic Hospital, Cappagh (NOHC) compared to Crumlin Hospital.

All three hospitals are connected under the Children’s Health Ireland (CHI) umbrella.

Only 2% of surgeries carried out at CHI at Crumlin did not meet the criteria set out during the look-back audit.

However, at CHI at Temple Street, around 60% did not meet the criteria, and 79% of those performed at the National Orthopaedic Hospital in Cappagh also failed to meet the retrospectively applied standards.

In one of the 147 cases reviewed, the audit revealed that a child had suffered complications following the surgery.

It also raises concerns about potential long-term issues for children who may have undergone unnecessary procedures.

This will be assessed during follow-up checks, with a total of 1,800 children to be reviewed.

The audit was carried out by Simon R.Y.W. Thomas, consultant paediatric orthopaedic surgeon at Bristol Royal Hospital for Children.

HSE CEO Bernard Gloster said the differing thresholds for surgery across the three sites are “of very serious concern” to him.

“The proportion of pelvic osteotomies taking place at CHI at Temple Street and NOHC, despite not reaching the international criteria used in the audit, was so high that the audit report says further inquiry is mandated,” he said on Friday.

The audit assessed whether the same standards for carrying out these surgeries were being used across CHI hospitals and the national orthopaedic site in Cappagh.

It also examined whether some of the procedures were unnecessary.

The audit recommends that all 497 children who underwent this surgery at either Temple Street or Cappagh hospitals between 2021 and 2023 be called for follow-up assessments.

While the author said he expects “the majority” to be functioning well, he also raised concerns about possible long-term complications.

Mr Gloster moved to reassure parents and guardians concerned about the findings.

The HSE also said: “We acknowledge and deeply regret the anxiety that the audit, and the time taken before publication, has caused to children and their families.” 

Taoiseach Micheál Martin said the "very, very concerning" report highlights issues of clinical performance and clinical governance at the hospitals involved.

"The minister will be moving quickly in terms of the governance question, to strengthen both clinical and overall governance in the CHI hospitals and also then, the necessity to widen the clinical inquiry and clinical follow up so that we engage with the parents and that there is clinical follow up with anybody who has had this surgery," Mr Martin said.

Jennifer Carroll MacNeill said she accepts the findings of an audit of hip surgeries and has asked for time to be allocated for a full discussion of the report to take place in the Dáil next week

The health minister said follow-up care for the children who underwent hip dysplasia surgery is the immediate priority following the publication of an audit report.

Jennifer Carroll MacNeill said she accepts the findings of an audit of hip surgeries and has asked for time to be allocated for a full discussion of the report to take place in the Dáil next week.

Responding to the report on Friday, Ms Carroll MacNeill said she is "deeply aware" of the worry parents are facing.

“I know that parents and young people themselves will have many questions when they read the report, and that the findings of this report will lead to worry and uncertainty for them," she said.

"My immediate priority is to ensure that there is clinical follow-up and care for patients who have undergone pelvic osteotomy surgery."

Parents can expect to receive letters from CHI and the National Orthopaedic Hospital, Cappagh (NOHC), over the coming days with arrangements for the next steps for their child and details on how to get further information.

According to Ms Carroll MacNeill, moves have been made to strengthen governance and oversight structures at CHI and NOHC.

This will include the appointment of two HSE board members to the CHI board and increased operational oversight via a strengthening of the Service Level Agreement between CHI and the HSE.

“I have also asked the HSE CEO, Bernard Gloster, to consider the implications of the audit for the NOHC and its oversight of paediatric surgery conducted at the hospital. The CEO has agreed to respond to this request within the next week," said Ms Carroll MacNeill.

Over 2,200 letters were sent by CHI to families whose children had this surgery, with some cases dating as far back as 2010.

Although the letters stated that the call-backs were routine, they caused significant distress among parents who were left wondering whether their child had undergone unnecessary surgery.

A draft version of part of the audit was published online last year, leading to high levels of concern, especially since the final version was only released on Friday.

CEO of Children's Health Ireland, Lucy Nugent said they accept the findings.

“I am sorry that impacted families were not offered one consistent and excellent standard of care across our DDH service,” she said, referring to the hip surgeries.

A helpline is being set up, open from Friday for parents with queries.

It will operate Saturday and Sunday from 9.00am to 5.00pm and again Monday - Friday from 8.00am to 8.00pm.

The numbers are Freephone 1800 807 050 or call 00 353 12408706 from outside Ireland.

It will be staffed by specialist nurses from CHI at Crumlin Hospital. Parents will be able to ask them questions about the process over the next few days.