Atlas 2015 - 3. Surgical interventions

Atlas

Key findings

The atlas examined seven surgical interventions and found highly variable use across Australia. In some areas, people 55 years and over had rates of knee arthroscopy that were more than seven times those of people living elsewhere. Even when the areas with the highest and lowest rates were excluded, knee arthroscopy hospital admission rates were more than four times higher in one local area compared to another. Despite the evidence that knee arthroscopy is of limited value for people with osteoarthritis and may cause harm, more than 33,000 operations were performed on this age group during 2012–13. Many of these people will have degenerative disease in their knees and will not benefit from this intervention.

The number of patients undergoing Medicare Benefits Schedule (MBS) funded cataract surgery was over seven times higher in some parts of Australia than in others. Even when the highest and lowest rates were excluded, the cataract surgery rate was almost three times higher in one local area compared to another.

From 2010–11 to 2012–13, there were 17,000 lumbar spine surgery admissions on average each year. This includes spinal fusion procedures. There is limited evidence to support lumbar spine fusion surgery for painful degenerative back conditions. The outcomes for patients who receive these interventions are unknown.

Women living in regional areas of Australia were more than five times more likely to undergo a hysterectomy or endometrial ablation than those living in metropolitan areas. Even when the highest and lowest rates were excluded, the rate was almost three times higher in one local area compared to another.

The atlas includes two ear, nose and throat procedures, tonsillectomy and myringotomy. Each procedure was performed more than 30,000 times during 2012–13, with people in some areas more than six times more likely to undergo the procedure. Even when the highest and lowest rates were excluded, tonsillectomy and myringotomy rates were around three times higher in one local area compared to another. Australia does not have recent evidence-based guidelines for performing tonsillectomy and myringotomy.

Recommendations

Knee arthroscopy hospital admissions 55 years and over

3a. The Commission recommends to the MBS Review Taskforce that, given the lack of clinical evidence for the efficacy of knee arthroscopy for people with degenerative changes in the knee that the relevant MBS item(s) be amended to remove knee arthroscopy for this group.

3b. The Commission develops a Clinical Care Standard1 for investigating and managing osteoarthritic knee pain based on recommendations from the Commission’s Knee Pain Expert Working Group.2

3c. State and territory health departments consider mechanisms to improve coding, analytics and collection of outcome data for knee arthroscopy.

3d. Relevant clinical colleges ensure education and training material, as well as continuing professional development requirements, are in keeping with the applicable Clinical Care Standard for management of osteoarthritic knee pain.

3e. The Commission promotes the collection of patient-reported outcome measures for surgical interventions for knee pain.

Cataract surgery 40 years and over

3f. The Commission works with the relevant clinical colleges to develop a Clinical Care Standard for cataract surgery, including considering pre- and post-operative visual acuity scoring.

3g. The Commission undertakes a quality review of existing patient information about cataract surgery as part of developing supporting material for a Clinical Care Standard on cataract surgery.

3h. The MBS Review Taskforce reviews the relevant MBS item(s) for cataract surgery to require adherence to an applicable Clinical Care Standard for the surgery. 

3i. State and territory health departments consider mechanisms to improve coding, analytics and collection of outcome data on cataract surgery. 

3j. Relevant clinical colleges ensure education and training material, as well as continuing professional development requirements, are in keeping with the applicable Clinical Care Standard on cataract surgery.

3k. The Commission promotes the collection of patient-reported outcome measures for cataract surgery.

Lumbar spine surgery hospital admissions 18 years and over

3l. State and territory health departments consider mechanisms to improve coding, analytics and collection of outcome data on lumbar spine surgery in adults.

3m. The Commission promotes the collection of patient-reported outcome measures for lumbar spine surgery.

Radical prostatectomy hospital admissions 40 years and over

3n. State and territory health departments consider mechanisms to improve coding, analytics and collection of outcome data on radical prostatectomy.

3o. The Commission promotes the collection of patient-reported outcome measures for radical prostatectomy.

Hysterectomy, endometrial ablation hospital admissions

3p. The Commission works with the Royal Australian and New Zealand College of Obstetricians and Gynaecologists and consumer groups to develop a Clinical Care Standard for managing menorrhagia.

3q. The Commission develops a patient decision aid to increase women’s knowledge of treatment options for menorrhagia and their benefits and risks. In addition, mechanisms are considered so that relevant clinical colleges can train clinicians to use this patient decision tool.

3r. Relevant clinical colleges ensure education and training material, as well as continuing professional development requirements, are in keeping with the applicable Clinical Care Standard for menorrhagia.

Tonsillectomy hospital admissions 17 years and under

3s. The Commission reviews the need for evidencebased clinical guidelines on tonsillectomy in children as part of the ongoing national guideline prioritisation processes. 

3t. The Commission reviews current patient information about tonsillectomy in Australia, in conjunction with relevant clinical colleges and consumer groups, to determine the need for better patient and carer information, and shared decision making tools, and also the need to update existing materials.

Myringotomy hospital admissions 17 years and under

3u. The Commission reviews the need for evidencebased clinical guidelines on myringotomy in children as part of ongoing national guideline prioritisation processes.

3v. State and territory health departments, in conjunction with the National Aboriginal Community Controlled Health Organisation, monitor adherence to the guidelines for managing otitis media in Aboriginal and Torres Strait Islander children and implement improvement activities.

Hip fracture hospital admissions and average length of stay in hospital 65 years and over

3w. Primary health networks and state and territory health departments work together to increase access to evidence-based falls prevention programs in hospitals, care facilities and the community.

3x. Private and public hospitals ensure patients have access to care that aligns with the Clinical Care Standard for acute management of hip fracture.

3y. Public hospitals implement the Clinical Care Standard for acute management of hip fracture through best practice pricing.

3z. Relevant clinical colleges ensure educational and training material, as well as continuing professional development requirements, are in keeping with the Clinical Care Standard for acute management of hip fracture

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Atlas 2015 - radical prostatectomy
Atlas 2015 - Hysterectomy & endometrial ablation
Atlas 2015 - Tonsillectomy
Atlas 2015 - Myringotomy
Atlas 2015 - Hip fracture hospital admissions
Atlas 2015 - Hip fracture average length of stay

Data sets