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More patients receiving knee and hip replacements in NSW could spend their first night after surgery at home as the state government seeks to cut down on public hospital bed block and a backlog of nearly 8000 people still waiting too long for elective surgery.
The state’s surgical care taskforce, established in May, has so far recommended five common procedures where patients can be discharged on the day. Co-chair Professor Neil Merrett said the group was now looking at how to make same-day joint replacement surgery more readily available across NSW.
The NSW surgical taskforce wants same-day joint replacement surgery more readily available across the state. Credit: Shutterstock
Merrett said a small number of hospitals, including Wagga Wagga Base Hospital and Grafton Hospital, were currently offering same-day discharge for those procedures.
The taskforce wants to expand the model statewide to hospitals “where they have the facilities and the backup to safely perform them”.
“What we’re doing is trying to decrease the amount of time patients are in hospital, and targeting those groups of patients that we’re certain are in the best possible shape for it,” Merrett said.
Trials in North America showed that between 25 and 40 per cent of patients were suitable for discharge within 24 hours of surgery, and a limited trial at Sydney’s Royal North Shore hospital showed it would be safe and effective for a similar proportion of patients.
Dr Andrew Ellis from the Australian Orthopaedic Association said although not suitable in every case, same-day joint replacement surgery was the “way of the future”.
“There’s definitely a future in Australia – in the next two or three years – where more patients are going home on the day of surgery,” he said.
More than 120,000 joint replacement surgeries are conducted in Australia each year, and that number is expected to double before 2030, according to research led by Monash University’s Professor Ilana Ackerman and funded by the HCF Research Foundation.
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The study estimates $641 million could be saved across public and private health systems over the next seven years if international short-stay joint replacement programs are implemented in Australia.
Australians receiving a joint replacement spent around five days on average in hospital after surgery, significantly longer than the United States, where patients spend an average of three days in hospital.
Ian Harris, a professor of orthopaedic surgery at the University of NSW, said the state government should prioritise reducing the amount of time all joint replacement recipients spend in hospital, rather than focusing on ramping up day-only knee and hip procedures.
“I think day only sounds good, but it’s just not achievable for the majority of patients,” he said. “Even if we halve it [average length of hospital stay] to two or three days, that means we can double the number of joint replacements.”
Harris said Australian taxpayers spend more per year on knee and hip replacements than any other procedure.
NSW Health Minister Ryan Park credited the state’s surgical taskforce for halving the number of people overdue for surgeries. Credit: Kate Geraghty
“We can’t just can’t afford to maintain a length of stay that is one of the longest in the world.”
Dr John Rooney, the head of orthopaedics at St Vincent’s Private Hospital in Sydney, said length of stays had been trending downwards, and he was “pretty confident we will be able to get to same-day procedures”.
“Everyone wants to sleep in their own bed,” he said. “The sooner people get out of hospital the better.”
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As of June, there were nearly 7000 patients on the waitlist for total knee replacement in NSW, and 3106 waiting for a hip replacement.
Of those, 365 were waiting longer than clinically recommended for hip surgery and 817 were overdue for knee replacements.
The number of patients waiting longer than clinically recommended for elective surgery in NSW fell from 14,067 in March to 7010 in September, according to data from the NSW Bureau of Health Information.
Health Minister Ryan Park, who committed to slashing wait times for elective or planned surgery when he assumed the role in March, said he was proud of the surgical taskforce’s efforts in halving the planned (elective) surgery waitlist.
“We have brought together some of the state’s leading clinicians in finding and embracing innovative solutions to improve the delivery of health care and ultimately, improve health outcomes for the people of this state,” he said.
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