Months to clear backlog of hip, knee surgeries
Some elective surgeries will be possible in alert level three, but it may take months to catch up on the operations that were cancelled during the lockdown.
Even before the pandemic disrupted hospitals, hundreds of people a year in Canterbury were being denied access to surgery because of capacity constraints.
New figures obtained by The Press after an intervention by the Ombudsman show a year-on-year increase in the number of people being rejected for first specialist assessments for knee and hip replacements in the region.
Overwhelmingly, the reason for people being rejected by the Canterbury District Health Board (CDHB) was capacity issues.
In 2018-19, of the 503 rejected hip referrals, just five were because patients fell below the clinical threshold for treatment. Of the 539 rejected knee referrals, only two fell below the threshold.
With the postponement of thousands of elective surgeries around the country during alert level four, the backlog of unmet need is only expected to grow.
‘‘I can understand them stopping the surgeries while we’re all in lockdown,’’ Canterbury woman Diane Clyma said.
‘‘Nobody could have expected it, but there’s still thousands of people waiting. It’s only going to make it worse.’’
Clyma, 52, was referred for a first specialist assessment by her doctor and a specialist multiple times from 2018 for surgery on her crumbling right hip joint.
She first spoke to The Press last December, detailing the multiple rejections and years living with increasingly debilitating pain.
To get surgery in New Zealand, people are first referred for a specialist assessment where a clinician assesses their level of need and the best course of action. To be accepted is a form of triage itself, so people who get an appointment are generally accepted for surgery.
Clyma eventually got her appointment in February, where she said a doctor agreed she needed surgery. She had a preoperation assessment later that month but was given no firm date for when the procedure would occur. Then everything changed.
She imagines her surgery will be delayed because of the pandemic but has no idea when it might take place.
Meanwhile, she is taking eight codeine pills a day as well as morphine to deal with the pain. ‘‘They call them elective surgeries, but they’re not elective. People ... don’t want these surgeries – they have to have them to survive.’’
The figures provided by the CDHB show the number of first specialist assessment referrals rejected for knees increased from five in 2014-15 to 120 the following year, then steadily increased to 539 in 2018-19.
For hips, the rejections started at 10 in 2014-15, went up to 107 the following year, then steadily increased to 503 in 2018-19.
Because of a change to a new information technology system, the CDHB had some concerns about the accuracy of the older data and the ability to compare pre- and post-change figures (most services moved onto the new system in October 2018).
Christchurch orthopaedic surgeon Dr John McKie said he and other surgeons were concerned at the number of people being declined surgery because of capacity constraints. ‘‘We know that there is a very large unmet need out in the community.’’
Ministry of Health guidelines say some elective surgeries would be possible at alert level three.
However, McKie said it would be a slow process starting up again, and access to surgery would be triaged based on who had the greatest need.
‘‘We’re going to be well behind the eight-ball, probably for several months, even to deliver the volumes that . . . are below what the community need and expectation is.’’