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Hospital Performance: Cancer surgery waiting times in public hospitals in 2011–12

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Summary

Cancer is a major cause of death and illness in Australia, being responsible for one-third of all deaths and one-fifth of the total burden of death and disability.1

This report examines waiting times for surgery for three of the most common cancers in Australia for which surgery is a key component of treatment: malignant bowel, breast and lung cancer. Waiting times for surgery for malignant cancers are a measure of access to potentially life-saving treatment. Without timely surgery, these cancers may progress and those with early-stage disease may face a reduced opportunity for cure.

In Australia there are no maximum acceptable waiting time benchmarks for planned cancer surgery. Surgeries are prioritised using the same waiting list system as other planned surgeries. The patients covered by this report were assigned to planned surgery waiting lists by surgeons as urgent or semi-urgent cases. Urgent cases are expected to be completed within 30 days, while semi-urgent cases are meant to be completed within 90 days.

In 2011–12 there were 31,988 surgeries for malignant bowel, breast, and lung cancer in Australia. Of these surgeries, 40% (12,699) were planned surgeries performed in public hospitals or in private hospitals on behalf of public hospitals. The remainder were performed in private hospitals or as emergency surgeries in public hospitals. This report shows waiting times across 155 of Australia’s public hospitals. Not all of these hospitals performed surgery for all three cancers (see Figure 2f, Figure 3f and Figure 4d).

The National Health Performance Authority reports the percentage of surgeries completed within the urgency category timeframe at each hospital. Because of the marked variation between hospitals in the proportions of patients assigned to urgent and semi-urgent categories in 2011–12, the Authority focuses this report instead on the percentage of patients receiving their surgery within 30 and 45 days and the median waiting time at each hospital.

There is no agreed definition of poor performance in relation to waiting times for cancer surgery. Therefore, the Authority makes no determination that any hospital is performing either well or poorly. Instead, the information in this report is intended to help health care professionals to see what is possible at similar hospitals and to support sharing of successful strategies to manage surgical care waiting lists.

Key findings

The report’s findings can be considered in the context of two themes:

  • The variation between hospitals in waiting times for surgery
  • The number of patients seen within 30 and 45 days for their surgery.

The variation between hospitals in waiting times for surgery

The report shows that most public hospitals provided timely surgery for malignant bowel, breast, and lung cancer in 2011–12. There were a small number of hospitals where some patients faced longer waits.

The median waiting time is the time within which half of patients received their surgery, meaning that the other half of patients at that particular hospital waited longer than this time.

Across major metropolitan hospitals, which account for 67% of all surgeries in this report, the median waiting times varied as follows:

  • Bowel cancer surgery: the shortest median waiting time at any hospital was 5 days and the longest was 37 days (Figure 2a)
  • Breast cancer surgery: the shortest median waiting time at any hospital was 6 days and the longest was 22 days (Figure 3a)
  • Lung cancer surgery (all major hospitals): the shortest median waiting time at any hospital was 4 days and the longest was 43 days (Figure 4a).

The report shows there were no apparent differences in median waiting times between major metropolitan and major regional hospitals for bowel and breast cancer surgeries. Due to the smaller number of hospitals performing lung cancer surgery, hospitals are not differentiated into metropolitan and regional groups.

Malignant bowel cancer surgery

In 2011–12, among the 49 major metropolitan hospitals performing planned surgery for malignant bowel cancer:

  • Thirty hospitals performed 90% or more surgeries within 30 days. Of these, five hospitals performed 100%
  • By 45 days, 44 hospitals had performed 90% or more surgeries. Of these, 17 hospitals performed 100%.

Among the 24 major regional hospitals:

  • Sixteen hospitals performed 90% or more surgeries within 30 days. Of these, four hospitals performed 100%
  • By 45 days, 22 hospitals had performed 90% or more surgeries. Of these, 11 hospitals performed 100%.

Among the 12 large hospitals:

  • Nine hospitals performed 90% or more surgeries within 30 days. Of these, five hospitals performed 100%
  • By 45 days, 10 hospitals had performed 90% or more surgeries. Of these, eight hospitals performed 100%.

Across all peer groups, 55 of the 85 peered hospitals completed at least 90% of malignant bowel cancer surgeries within 30 days. Of the 30 remaining hospitals those with the lowest percentages of patients who had surgery within 30 days were Princess Alexandra, Qld (39%), Calvary Mater [Newcastle], NSW (47%) and Fremantle, WA (52%) (Figure 2b to Figure 2d).

By 45 days, 76 of the 85 hospitals completed at least 90% of malignant bowel cancer surgeries. Of the nine remaining hospitals those with the lowest percentages of patients who had surgery within 45 days were Princess Alexandra, Qld (61%) and Fremantle, WA (68%) (Figure 2b to Figure 2d).

Malignant breast cancer surgery

In 2011–12, among the 44 major metropolitan hospitals performing planned surgery for malignant breast cancer:

  • Thirty-nine hospitals performed 90% or more surgeries within 30 days. Of these, eight hospitals performed 100%
  • By 45 days, all hospitals had performed 90% or more surgeries. Of these, 22 hospitals performed 100%.

Among the 25 major regional hospitals:

  • Twenty hospitals performed 90% or more surgeries within 30 days. Of these, five hospitals performed 100%
  • By 45 days, all hospitals had performed 90% or more surgeries. Of these, 17 hospitals performed 100%.

Among the 14 large hospitals:

  • Twelve hospitals performed 90% or more surgeries within 30 days. Of these, six hospitals performed 100%
  • By 45 days, all hospitals had performed 90% or more surgeries. Of these, nine hospitals performed 100%.

Across all peer groups, 71 of the 83 peered hospitals completed at least 90% of malignant breast cancer surgeries within 30 days. Of the 12 remaining hospitals those with the lowest percentages of patients who had surgery within 30 days were Calvary Mater [Newcastle], NSW (78%) and Nambour, Qld (79%) (Figure 3b to Figure 3d).

By 45 days, all 83 hospitals completed at least 90% of malignant breast cancer surgeries (Figure 3b to Figure 3d).

Malignant lung cancer surgery

In 2011–12, among the 28 major metropolitan and regional hospitals performing planned surgery for malignant lung cancer:

  • Seventeen hospitals performed 90% or more surgeries within 30 days. Of these, nine hospitals performed 100%
  • By 45 days, 25 hospitals had performed 90% or more surgeries. Of these, 16 hospitals performed 100%.

The hospitals with the lowest percentages of patients seen within 30 days were Liverpool, NSW (36%) and Princess Alexandra, Qld (67%) (Figure 4b).

The hospitals with the lowest percentages of patients who had surgery within 45 days were Liverpool, NSW (55%) and St George, NSW (88%) (Figure 4b).

The number of patients seen within 30 and 45 days for their surgery

In 2011–12, most (91%) of the 12,699 patients in this report received their surgery within 30 days. This means that nationally, 1,090 patients waited longer than 30 days for their surgery for malignant cancer.

Nearly all patients (97%) received their surgery within 45 days. This means that nationally, 382 patients waited longer than 45 days for their surgery for malignant cancer.

The number of patients who received bowel, breast and lung cancer surgery within 30 and 45 days is provided in Figure 2f, Figure 3f and Figure 4d.

1
Australian Institute of Health and Welfare; Australasian Association of Cancer Registries. Cancer in Australia: an overview, 2012 [Internet]. 2012 [cited 2013 Nov 4]; Cancer series no. 74. cat. no. CAN 70. Available from: http://www.aihw.gov.au/publication-detail/?id=60129542359
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