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Local News - Victoria

Elective surgery resumes amid warning over post-op complications


Professor David Story, of the Australian and New Zealand College of Anaesthetists, said he was concerned about elective surgery patients battling chronic health conditions such as diabetes, heart disease and hypertension, who might have delayed seeing GPs and specialists.

“Our concern is a lot of the patients who are now coming in are often a bit older and often have diseases, which may have worsened because there have been delays in diagnosis or getting their surgery,” he said.

“Some of the flow-on effects for this may be greater need for unplanned critical care admissions, so more ICU admissions post-surgery. We still expect relatively small numbers, but it might mean there are more medical emergency team calls and re-admissions of patients with complications.”

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Victoria recorded 42 new coronavirus cases on Wednesday as Melbourne’s crucial 14-day case average fell below 50 for the first time since the second wave peaked, and the number of active cases dropped below 1000 for the first time in months.

The Premier has set an ambitious goal of 18,750 additional elective surgeries across private and public hospitals in October, and an extra 10,500 surgeries in November.

Elective procedures will go up from 50 per cent to 75 per cent of usual surgeries from Thursday as part of eased restrictions in country Victoria. In Melbourne, that is likely to increase to 75 per cent from September 28.

Mr Andrews said regional Victoria would increase to 85 per cent capacity by September 28 before going back to a normal elective surgery schedule by late October.

In Melbourne, as long as road map targets are met, surgery capacity will scale up to 85 per cent late in October with the introduction of stage two restrictions.

The announcement came as Victoria’s total active cases of coronavirus dropped to 991.

“That is very, very significant – it’s been a long time since we’ve had less than 1000 active cases,” Mr Andrews said.

Mr Andrews said every patient would be tested for coronavirus before scheduled elective surgery. However, he said it was not always possible to screen patients for COVID-19 when they needed emergency surgery. “Obviously, in some situations that is not always possible. People come in and need to be operated on immediately.”

Professor Story said stringent screening of patients for coronavirus before and after surgery was critical, amid growing global evidence those infected with the virus were at heightened risk of dying or complications.

“We are concerned about patients who may have coronavirus, but we have really good testing and screening happening for that at the moment,” the medical college’s safety and quality committee chair said.

“The really important thing is that it is gradually increased so it can be closely monitored and that it is done on the basis of need for patients.”

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A major global study of more than 1000 elective surgery patients, including those who underwent minor procedures, across 24 countries between January 1 and March 31 found the death rate for patients with COVID-19 was almost 19 per cent.

Between 5 and 10 per cent of patients experience complications post-operatively, but Professor Story predicts this will rise as a result of the pandemic.

The announcement was also welcomed by Australian Dental Association Victoria chief executive officer Matthew Hopcraft who said dentists had been inundated by patients presenting for emergency treatment for broken teeth, swollen gums and infected wisdom teeth.

“The main thing is being able to give certainty to patients around when they can receive treatment,” Professor Hopcraft said. “The delays in treatment have caused a lot of angst among dentists and patients who have had their treatment delayed on and off since March.”

Among them is Jennifer Dorell, who has been anxiously waiting for upper and lower jaw surgery to fix an overbite so she could get her braces off this year.

Ms Dorell was scheduled to have her jaw surgery in April, but it was cancelled as coronavirus infections soared.

“I am very over it,” she said. “Anyone who has had braces knows how they cut into your gums and the pain you get with them as well. The uncertainty has been really difficult.”

Ms Dorell expects she will still have to wait up to six months to have her surgery.

“They will likely put patients needing more urgent care ahead of me, which I completely understand,” she said. “I will have to keep my braces for another six months after surgery. That will mean I will have had my braces for almost five years. It has all been pretty disheartening.”

Melbourne man Terry Brown underwent a hip replacement earlier this year, but his rehabilitation has been hindered while he awaits a knee surgery.

“My recovery has plateaued at the moment because both my knees are gone,” the 65-year-old Pascoe Vale man said.

“One of them is really bad and causes me a lot of pain. It makes your life very difficult because you don’t sleep well because of the pain. I try to walk every day, but I come home and my knees are killing me after that.”

Mr Brown is hopeful the resumption of elective surgeries will mean he is able to get his left knee replaced before Christmas.

“It is a big relief,” he said.

Victorian Health Minister Jenny Mikakos said anyone awaiting category two or three surgery could have their case reviewed to determine their priority.

She dismissed claims by the state opposition that the number of patients waiting had ballooned to more than 100,000 as “made up”.

Category two surgeries are procedures that need to happen within 90 days and that cause pain or disability, but are unlikely to escalate to an emergency. This could be something like a standard heart valve replacement. Category three surgeries include procedures such as hysterectomies and hip and knee replacements.

Australian Medical Association Victorian vice-president Roderick McRae said the process must be monitored closely and regularly audited.

“Broadly we are supportive of a staged increase of medical and dental procedures, but it needs to be a slow and sensible ramp up of work,” Dr McRae said.

He added said the resumption of elective surgery must not impede on public hospital capacity to deal with respiratory emergencies.

“The key is we need to keep an operational eye on everything that’s going on,” he said. “If there is a sudden outbreak, then we need to be able to jump on that in a targeted way that does not mean shutting down Victoria.”

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Local News - Victoria

Victoria records 348 COVID-19 cases and six deaths, elective surgery suspended


“We don’t run this sector but the residents in these homes are all Victorians. The Commonwealth government have asked for help and that is exactly what my government and our agencies will provide.”

Elective surgery for those other than category one and the most urgent category two patients will be suspended, to make sure hospitals have the beds, equipment and staff available if aged care residents need to be transferred, he said.

Of the Victorians who died in the past day, three were aged in their 80s, two in their 90s and one in their 70s.

Mr Andrews said the outbreaks in aged care were a “critical challenge”, however residents would not be moved out en masse.

Aged care makes up 769 of the 4775 active cases of COVID-19 in Victoria.

About 2000 residents have already been moved from private sector aged care to public and private hospitals.

Mr Andrews said the response to the crisis would be co-ordinated out of the State Control Centre.

“This is a shared challenge,” he said.

“My commitment to all is we will do everything we can with this, everything we’re asked to and we’ll go above and beyond that. We owe it to each of those residents. We owe it to their families.”

Over 170 residents have been moved out of aged care facilities hit by COVID-19 outbreaks, with more transfers planned in coming days.

Premier Daniel Andrews said he couldn’t put a number on how many would be moved to hospitals, however he said it would be a “massive exercise”.

“I would make the point again that the vast majority of residents will be safer to stay in their home but have additional care,” he said.

The state’s death toll from COVID-19 is now 83. There are now 260 people in hospital in Victoria with coronavirus, 45 of them in intensive care.

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Tuesday’s 384 cases represent a significant drop from Monday’s record figure of 532.

Epidemiologists say the daily numbers are not a very good guide to the overall state of the epidemic, and that Victoria’s COVID-19 pandemic may have peaked.

The crucial number is the effective reproduction number, which measures whether an epidemic is growing or shrinking. If the number is one, the epidemic is considered to be stable.

Chief Health Officer Brett Sutton said the number was calculated twice a week and he said on Tuesday he expected it would be “very close to one, if not below one”.

“So there should be a downward pressure on transmission in the community but, again, whenever you have a setting that allows for significant outbreaks to occur that can also drive that R number up,” he said.

Babies in the neonatal intensive care unit at the Royal Children’s Hospital have returned negative tests after four cases were linked to the ward on Monday.

Two parents, one patient and a healthcare worker at the RCH recently tested positive to COVID-19.

Health Minister Jenny Mikakos said all follow-up tests of babies had come back negative, with one still pending.

Victoria Police issued 79 fines in the past 24 hours for breaches of coronavirus restrictions, five of which were issued at vehicle checkpoints.

Almost a third of the fines (23) issued on Monday were to people in Melbourne’s lockdown zone who refused to wear a face-covering.

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Melbourne’s elective surgery patients to be tested for COVID-19


Victorian Health Minister Jenny Mikakos on Friday.

Victorian Health Minister Jenny Mikakos on Friday.Credit:Joe Armao

The announcement comes after outbreaks among staff in at at least a dozen hospitals in recent weeks, including The Alfred, the Northern Hospital, the Royal Melbourne, the Royal Women’s, Brunswick Private, Box Hill Hospital and St Vincent’s.

Tony Bartone, president of the Australian Medical Association, welcomed the initiative, but warned that the new testing program should not lead to complacency over personal protective equipment and safety protocols in hospitals.

“We still need to take all the appropriate precautions to protect our healthcare staff as best as possible, regardless of whether a test says yay or nay,” he said.

Dr Bartone said the single-test plan was not foolproof in stopping coronavirus being introduced to hospitals.

“There is a lag period between the test and the result,” he said. “You could test negative but depending on where in the incubation cycle the virus is, you could still develop it a few days later.”

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He said testing people before elective surgeries had been considered earlier in the pandemic, but at the time it was not considered a priority.

“With the low level of community transmission at the time, it is not the best use of scarce resources,” he said.

Dr Bartone said that, even now, community testing – especially in hotspot zones, public housing and aged-care facilities – was much more important than testing patients on surgery waiting lists.

“What we really need to be doing is really seeking and reaching out to all the possible cases in the available areas where we know we’ve got increased transmission,” he said.

“They need to be religiously tested and followed up.”

Ms Mikakos said those requiring emergency surgery would not need to be tested or wait for a result.

A Sunshine Hospital nurse was infected with COVID-19 after treating a coronavirus-positive Cedar Meats worker who needed emergency care on a severed thumb.

The testing plan comes as the state reduces its elective surgery capacity to 75 per cent in case hospitals become flooded with coronavirus patients.

The state government had originally planned to allow all Victorian hospitals to return to 100 per cent of their usual elective surgery operating theatre capacity in July, but reversed the stance last week.

Ms Mikakos has encouraged people with health problems to keep seeking treatment during the crisis, despite the decision on elective surgeries.

“It’s important people continue to look after their health during the pandemic – no one should put off seeking medical care if they need it. Our hospitals are safe and open to everyone,” she said.

Patient advocates have called on governments to unveil a plan to catch up on surgery waiting lists.

With Dana McCauley

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Victoria COVID-19 cases surge past 450, Scott Morrison flags elective surgery cancellation


“They perform a vital role on our front line and must be protected so they can continue to perform their duties,” Mr Cook said.

WA Premier Mark McGowan

WA Premier Mark McGowanCredit:Lauren Pilat

This comes as WA Premier Mark McGowan wants two cruise ships sailing off the WA coast out of the state’s waters and heading home.

The MSC Magnifica, which has reported no unwell patients, and the Artania, which has suspected COVID-19 patients, are both near Fremantle.

Mr McGowan said the Artania had reported 25 passengers and crew with respiratory symptoms. One passenger, who is no longer aboard the ship, had tested positive to COVID-19.

The Artania requested assistance with health assessments and COVID-19 testing last night. WA Health Department officials are on board the ship, but results of testing will not be known until later tonight.

The Magnifica has been denied access to ports in Dubai, which was its next port of call and has returned to Fremantle.

In addition, preparations are under way for Australian passengers on board the Vasco da Gama to be quarantined on Rottnest Island, off Perth.



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