Dozens of hip surgery children did not meet expert's criteria for procedure
Dozens of children who underwent hip surgeries at Cappagh and Temple Street did not meet an international expert's full criteria for hip surgery, a damning new report has found.
In nearly 80% of cases at Cappagh Orthopaedic Hospital and 60% of cases at Temple Street, lower decision-making thresholds were used to decide whether surgeries should be conducted.
It is likely that hundreds of children may have been operated on at a lower threshold, as it is understood that it is likely this standard was applied going back "many years".
CHI and National Orthopaedic Hospital at Cappagh (NOHC) commissioned an audit after a whistleblower raised concerns about the thresholds used to decide whether to perform surgery for children with Developmental Hip Dysplasia (DHD) at Temple Street and Cappagh.
This surgery relates to the failure of the full formation of the hip socket in children. It can be identified through screening and is followed up with other investigations such as X-rays and ultrasound.
CHI commissioned UK-based Consultant Paediatric Orthopaedic Surgeon Mr Simon Thomas to review a random sample of surgery cases carried out on children aged between one and seven between 2021 and 2023 across Temple Street, Crumlin, and Cappagh hospitals.
In total, Mr Thomas reviewed 147 random and anonymous cases across the three hospitals.
The report found that there were significantly different thresholds for recommending pelvic osteotomy procedures between Crumlin, Temple Street and The National Orthopaedic Hospital in Cappagh.
At CHI Crumlin, the threshold for performing hip surgeries on children was fully in line with the criteria used by the international expert who wrote the report.
However, Mr Thomas raised concerns about the threshold for surgery in many cases in Temple Street and Cappagh Hospital.
What was called 'novel picking' was used. In this context, an existing but less invasive procedure was completed, but questions were raised about the threshold for surgery.
Mr Thomas sampled 51 cases out of a total of 114 surgeries done at Cappagh. Of 70 pelvic osteotomies, just 15 met the audit criteria (21%).
At Temple Street, 49 cases were audited out of 127 that took place in the hospital between 2021 and 2023. Out of 85 pelvic osteotomies, 34 met the audit criteria (40%).
At Crumlin, 47 cases of 101 were audited. Of 63 pelvic osteotomies, 62 met the audit criteria
This means that 79% of surgeries at Cappagh and 60% of surgeries at Temple Street did not reach the criteria required for surgery set out by Mr Thomas.
The audit also identified one case from the review sample where a child experienced complications due to the surgical approach recommended to them.
Mr Thomas said in many of the Crumlin and Cappagh cases sampled, there was no record of closed or open hip reduction after delayed diagnosis, no record of either hip ever having been dislocated and 'often no history of treatment soon after birth by splint or brace for hip instability'.
All 497 cases that have undergone pelvic osteotomy at Cappagha and Temple Street between 2021 and 2023 now require ongoing follow-up to skeletal maturity.
These families will be recalled and should undergo an independent clinical review and radiological assessment, the report stated.
This group of patients will be contacted directly to explain what this means and the next steps for them.
An external independent panel of surgeons with expertise in DDH surgery is currently being established to review all patients who underwent surgery for DDH in CHI at Temple Street from 2010 and Cappagh from 2021 to establish whether the criteria for surgery aligned with acceptable parameters as determined by the expert panel. Families will be involved throughout this process.
Bernard Gloster, CEO of the HSE, said that the variance in surgical practice between Cappagh and Temple Street was concerning.
He said: '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.
'Focus on follow-up and putting in place a mechanism to ensure this kind of variation can't recur is central to our next steps, and we will be working with everyone to ensure that this can't happen again.
CHI and Cappagh Hospital have established a dedicated contact number which will be supported by clinical staff and will support patients and families who are seeking further information about their care and the next steps.
The phone line is open Monday to Friday 8am to 8pm, and Saturday and Sunday 9am to 5pm. The number is Freephone 1800 807 050, or 00 353 1 240 8706 from outside Ireland.
Health Minister Jennifer Carroll MacNeill said she has 'moved immediately to strengthen governance and oversight structures at CHI and NOHC'.
She said: 'In responding to this Report, I am thinking first and foremost of the impact a surgery has on a child. I am also deeply aware of the worry that parents will face today and this is something that is sitting with me all the time.
'My immediate priority is to ensure that there is clinical follow-up and care for patients who have undergone pelvic osteotomy surgery.
'This follow-up will be in accordance with best practice and the recommendations of the Report.'
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