20 August 2015
by Geoff Winestock

Is some surgery making us sicker?

Doctors are performing thousands of costly procedures including knee surgery and back operations which are known to be quite useless but the current system is not doing enough to educate them.

A report by the Grattan Institute Questionable care: avoiding ineffective treatments says doctors performed about 800 arthroscopies a year on people with osteoarthritis, even though there is strong evidence that for this class of patient the treatment, which involves inserting a tube to remove damaged knee tissue, is no better than a placebo.

About 4600 patients were treated with hyperbaric oxygen therapy, which involves breathing oxygen in a pressurised room, even though they were suffering from conditions such as cancer, osteomyelitis or non-diabetic wounds where the treatment is useless.

Another 300 people with osteoporotic spinal fractures were given a treatment called vertebroplasty, which involves filling a backbone with cement, even though it is ineffective for that condition.

The report argues governments should be doing more to identify and publicise so-called "do not do" and "do not do routinely" operations.

"Each year, thousands of patients get treatments that cannot help them. The consequences are serious. Their original health problem remains and the intended cure might make them sicker," said Professor Stephen Duckett, a co-author of the report.

The Grattan report recommends asking the Commission on Safety and Quality in Health Care to compile clearer guidelines on "do not do" procedures based on latest evidence. If, after a process of education and clinical review, hospitals fail to change their ways they should face "serious consequences" such as funding cuts. It says private insurers should also be able to withhold funding for unnecessary treatments.

Thousands of 'do not do' procedures
Stephen Parnis, vice-president of the Australian Medical Association, said doctors supported spreading more information throughout the profession but he was opposed to people who were not doctors making decisions about treatment with an agenda of cutting costs. "There is a lot of ambiguity about which treatment is suitable and which is not. We do not want non-clinicians wielding a big stick."

He said the battle now raging between insurer Medibank Private and Calvary Health Care was an example of patient care suffering as a result of cost cutting.

The report published on Monday in The Medical Journal of Australia found there were huge variations between hospitals in the prevalence of "do not do" procedures which could not be explained by differences in the type of patients and cases going to hospitals.

Private hospitals in Western Australia and NSW are 10 or 12 times more likely to perform osteoporotic spinal vertebroplasty than the average while public hospitals nationally are 2.5 times more likely to do knee surgery for arthritis patients than private hospitals.

The report said about 126 hospital departments a year accounted for the vast bulk of the greater than average use of these "do not do" procedures.

It also highlighted "do not do routinely" procedures which can be effective but which are not considered a best first choice in most cases.

In childbirth some hospitals are much more likely to perform episiotomy, a cut between the vagina and the anus, even in cases without complications. They also make greater use of amniotomy, an artificial rupture of membranes to speed up labour.

It found hospitals have not reduced the rate at which they perform operations using tubes called grommets to remove fluid from the middle ears of children, despite evidence 15 years ago that delaying an operation posed no development risks to the children and antibiotics could be tried first.