Surgery complication and wait times dash NSW health system's glowing record

Patients in NSW public hospitals have higher rates of complications and longer wait times for some of the most common surgeries compared to comparative health systems internationally, a new independent analysis shows.

Australia's most populous state outperformed its international peers on a range of health system measures, but fell down when it came to adverse events, readmissions as well as inappropriate or delayed surgeries, according to the Bureau of Health Information's 'Healthcare in Focus' report.

NSW was the worst among eight comparator countries for hip fracture surgeries performed on time, with more than one in four patients waiting more than two days for their operations.

The state's surgeons are still performing a huge amount of inappropriate surgeries, with 70 per cent of knee arthroscopies performed on people aged over 55 with osteoarthritis, despite evidence showing it is of little benefit in these patients.

The report published Wednesday also found marked disparities between the rich and poor in elective surgery wait times at public hospitals, patients from low socio-economic areas waiting almost twice as long as those from affluent areas (66 versus 38 days).

Hospitals were not discriminating against patients, rather hospitals surrounded by lower socio-economic communities had longer wait times, acting BHI chief executive Dr Kim Sutherland said.

NSW patients waited longer for cataract, knee and hip replacements than most other jurisdictions, despite almost all patients being wheeled into operating rooms within the clinically recommended timeframes, compared the NSW health system against 11 countries and all other Australian states and territories.

The median wait time for cataracts surgery was 222 days over the report period, ranking NSW 15th out of 16 countries, including Canada, New Zealand, the US, UK and Germany.

The median wait time across all elective procedures in NSW had risen from 49 to 55 days between 2011 and 2016, the report showed.

Health Minister Brad Hazzard recently announced $3 million in funding would be dedicated to cutting elective surgery wait times

NSW had a relatively high complication rate for surgeries, with 2.5 per cent of hip and knee replacement patients developing venous thromboembolism and 2.5 per cent of those who underwent abdominal surgery developing sepsis.

The rate of falls where a patient was injured was also relatively high at 5.6 per 1000 hospitalisations.

Of all patients admitted to NSW public hospitals, 6.5 per cent had an unintended or potentially harmful adverse event, including bloodstream infections, complications or falls, placing NSW in the mid-range of other Australian states and territories.

But Dr Sutherland said NSW hospitals could be better at detecting these complications compared to other jurisdictions, rather than causing more of them.

Of the 2.6 million emergency presentations 6 per cent turned up at an ED within two days, and 10 per cent within seven days.

Among fracture patients aged over 50, 14 per cent were readmitted to hospital within two years for another fracture, according to admissions data between July 2011 and June 2013.

Among psychiatric inpatients, 15 per cent had an unplanned readmission within 28 days in 2015-2016.

NSW was in the middle of the pack for seclusion on mental health units, with nine per 1000 psychiatric inpatient stay involving the restrictive practice.

Seclusion and restraint is the subject of a statewide independent inquiry led by the NSW chief psychiatrist, who is pushing for their complete elimination.

NSW was also mid-range for community psychiatric services with 63 per cent of patients receiving follow up support within a week of being discharged compared to 48 per cent in 2010.

No country spent fewer health dollars per capita and achieved better outcomes, said BHI acting chief executive Kim Sutherland.

While there was considerable room for improvement across these measures, the state's health system overall was performing well, Dr Sutherland said.

NSW was considered a higher performer across 40 per cent of measures and a mid-range performers for another 40 per cent.

"Deaths from heart attack and stroke have fallen sharply over the decade," Dr Sutherland said.

"Healthcare is accessible to most people in NSW and patients generally receive it in a timely and safe way."

Dr Sutherland said no jurisdiction spent fewer health dollars per capita and achieved better outcomes for patients.

In 2014-2015 NSW spent an estimated $46 billion or $6122 per person.

This story Surgery complication and wait times dash NSW health system's glowing record first appeared on The Sydney Morning Herald.