Surgery delay after hip break led to death
An elderly woman who tragically died after waiting five days for hip surgery prompted a coroner to raise concerns that a hospital is putting patients at risk of an early death.
Anne Rowland, a care home resident in Oxted, died in East Surrey Hospital after inflammation and infection of the lungs following surgery.
Ms Rowland broke her hip following a collision and fall with another care home resident who was partially sighted on February 27, 2023. She was taken to East Surrey Hospital the same day.
Coroner Anna Crawford found there was “no clinical reason” for the surgery not taking place until five days later on March 3 as the patient was “clinically fit”.
She concluded that outstanding infrastructure repairs and the use of different guidelines from the National Institute for Health and Care Excellence (NICE) that the Surrey and Sussex Healthcare NHS Trust was “placing patients at risk of early death”.
NICE guidelines say that hip surgery should take place on the day of the injury or the day after. Early mobilisation is recommended for hip fracture patients to reduce the risk of complications, including pneumonia.
East Surrey Hospital uses a metric of 48 hours within which to conduct such surgery and does not use the NICE timeframe. Although the hospital has a dedicated operating theatre for trauma patients, on some occasions demand outweighs capacity.
However, the surgery did not take place because “other trauma patients were prioritised ahead of [Mrs Rowland] based upon their relative clinical need”.
Operating theatre capacity at the hospital has on occasion been compromised by infrastructure failings. An entire new surgery unit is being constructed and is anticipated to be completed by 2025 at the latest. The orthopaedic theatres also need new air handling and chillers which is yet to be completed.
The coroner concluded that waiting for her operation “caused” Mrs Rowland to develop dementia and immobility. This “contributed” to her developing aspiration pneumonia following surgery. Mrs Rowland’s condition deteriorated resulting in her death at East Surrey Hospital on March 31, 2023.
Ed Cetti, chief medical officer of Surrey and Sussex Healthcare NHS Trust, said: “We are profoundly sorry for the delay in Mrs Rowland’s hip surgery and offer our deepest sympathies to her family during this difficult time.”
The Trust said that in the months since Mrs Rowland’s death, it has “significantly” reduced delays in hip fracture surgery. In November 2023 59 per cent of operations occurred within 36 hours and 91 per cent within 48 hours.
Mr Cetti added: “We always strive to perform surgeries of this nature as soon as possible and monitor our performance against the 36-hour time window identified by NICE guidance. We also monitor against a 48-hour window to ensure any patients that miss the 36-hour target are not waiting longer than 48 hours.
“Recognising that not all patients are medically well enough for surgery within 36 hours, we are working on improving our performance further and reaching the 80 per cent target by the end of 2024/25.”
Image: Entrance to East Surrey Hospital. Credit Get Surrey.
