Value-based surgery

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Value-based surgery supports safe, effective and timely care by ensuring patients receive the right procedure, for the right reasons, at the right time.

In doing so, it maximises the benefits of health resources by matching them to evidence-based outcomes, best practice, and personalised outcomes that are aligned with a patient’s preferences.

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Clinical practice guide

Published: November 2023. Next review: 2027.

This clinical practice guide provides evidence-based advice for clinicians to enable more clinically appropriate procedures to be performed in NSW public hospitals.

Procedures include:

  • Knee arthroscopy
  • Tonsillectomy
  • Myringotomy without insertion of grommets
  • Hysterectomy
  • Asymptomatic hernia repair
  • Lumbar spinal fusion for back pain alone
  • Colonoscopy

Download the Value-based surgery: Clinical practice guide guide (PDF 767.0 KB)

Tranche 2 procedures

The minimisation of inappropriate clinical variations is an important part of value-based healthcare. Tranche 2 resources build on the foundations of the original clinical practice guide above, and reflect the latest peer-reviewed evidence, clinical consensus, published national standards and local insights to support high-value care appropriate to the patient cohorts likely to benefit from treatment.

Tranche 2 incorporates local data on clinical variation across local health districts, highlighting differences in practice and reinforcing the importance of staged treatment, escalation pathways and using these procedures judiciously and in line with best evidence.

Tranche 2 provides guidance on:

While hysterectomy and spinal fusion are included in the clinical practice guide above, tranche 2 applies a more focused lens, with clear criteria and factors for consideration for determining patient eligibility. The updated guidance on hysterectomy specifically addresses its use for heavy menstrual bleeding.

These resources complement, not override, clinical judgement and the therapeutic relationship between clinician and patient.

Audit indicators for value-based planned procedures

Audit indicators for planned surgical procedures:

Considerations for culturally and linguistically diverse patients

Care should be delivered in a way that is sensitive to cultural, religious and interpersonal differences, including but not limited to sexual orientation, gender identity, physical and intellectual abilities, and accessibility needs.

For patients from culturally and linguistically diverse (CALD) backgrounds, it is important to ensure that communication is clear, respectful and inclusive. A professional interpreter service should be engaged for patients, careers or support people who are deaf, hard of hearing, or who prefer a language other than English. Where possible, written information should be provided in the patient’s preferred language, and clinicians should be mindful of cultural values, health beliefs and decision-making practices that may influence consent, expectations and recovery.

Data source

The NSW Admitted Patient Data Collection was accessed via the Hospital Performance Dataset, NSW Ministry of Health Secure Analytics for Population Health Research and Intelligence.

Acknowledgements

Thank you to the following people who were involved in the development of the tranche 2 resources.

  • Deborah Burrows, District Clinical Nurse Consultant Perioperative Services, Southern NSW Local Health District
  • Professor Neil Merrett, District Program Director of Surgery, South Western Sydney Local Health District
  • Peta McIntyre, Perioperative Network Lead, Murrumbidgee Local Health District
  • Phillip Middleton, Network Clinical Director Surgery and Anaesthetics, Northern Sydney Local Health District
  • Soni Putnis, Medical Clinical Co-Director, Surgery, Illawarra Shoalhaven Local Health District
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