Audit Findings on Unnecessary Hip Surgeries in Children’s Hospitals (2021–2023)
Locations
An independent clinical audit has revealed findings regarding the surgical treatment of children diagnosed with developmental dysplasia of the hip (DDH) at two Irish hospitals. The audit, commissioned by Children’s Health Ireland (CHI) and the National Orthopaedic Hospital Cappagh (NOHC), examined 147 randomly selected DDH surgeries performed between 2021 and 2023 across three institutions: CHI at Temple Street, CHI at Crumlin, and NOHC.
Concerning Findings
- Temple Street Hospital (TSH): Of 85 surgeries reviewed, 51 (60%) did not meet the clinical criteria for surgery.
- National Orthopaedic Hospital Cappagh (NOHC): Of 70 surgeries reviewed, 55 (79%) were deemed unnecessary.
- CHI at Crumlin: Only 1 of 63 surgeries failed to meet the criteria, indicating significantly higher adherence to clinical standards.
One child who underwent an unnecessary procedure suffered an adverse outcome, underscoring the real and lasting impact of these decisions.
Clinical and Ethical Concerns
The audit, led by Mr Simon Thomas, Consultant Paediatric Orthopaedic Surgeon, concluded that the discrepancies in surgical decision-making between hospitals could not be attributed to normal clinical variation.
Families of the children affected will understandably fear that the audit's findings point to systemic inconsistencies in the application of surgical criteria, raising questions about governance, competency and patient safety.
Health Officials' Response to the Findings
Senior health officials have publicly acknowledged the gravity of the findings; Lucy Nugent (CHI CEO) issued a heartfelt apology to affected families, particularly to the family of the child who experienced complications. Angela Lee (NOHC CEO) expressed deep regret for the distress caused and Bernard Gloster (HSE CEO) emphasised the need for systemic safeguards to prevent recurrence.
What Happens Next?
The report mandates several urgent actions:
- Comprehensive Patient Recall: All 497 children who underwent DDH surgery at TSH and NOHC during the audit period must be recalled for independent clinical and radiological review.
- Standardisation of Care: CHI has committed to implementing uniform clinical guidelines across all sites to ensure consistent, high-quality care.
- Peer Review and Oversight: Surgeons at TSH and NOHC are to engage in cross-site peer review to align surgical decision-making with best practices.
- Governance Reform: The Minister for Health has initiated governance enhancements, including the appointment of HSE board members to the CHI board.
Implications for Legal Action
The high percentage of surgeries performed, seemingly without clinical justification, coupled with at least one documented adverse outcome, may constitute negligence. The recall of nearly 500 patients underscores the scale and seriousness of the issue but there may be considerably more people affected. Earlier this month, it was discovered that unnecessary surgeries on children may have been occurring for as far back as 15 years ago, and that families have been written to.
This audit reveals a profound failure in safeguarding the wellbeing of vulnerable children. The emotional and physical toll on families affected by unnecessary surgeries cannot be overstated. It is imperative that there is complete accountability, and that affected families receive the support, answers, and justice they deserve.
Written by Joahn Verbruggen.