Three per cent of an orthopaedic surgeon’s patients who underwent bilateral knee replacement surgery at Albury Wodonga private hospital died, a New South Wales coroner has heard.
Kenneth Toll, 62, died on 20 July 2019 three days after undergoing the elective surgery at the hospital. The inquest, which began on Monday, is examining the medical care and treatment provided to Toll in the lead-up to his death.
Orthopaedic surgeon Elie Khoury performed the surgery and confirmed he had performed 94 bilateral knee replacements at the hospital, which is managed by Ramsay Health Care, Australia’s largest private hospital operator.
Under questioning by the barrister representing the family, Jennifer Hillier, Khoury confirmed he had performed 94 bilateral knee replacements at the hospital and that three of those patients had died, including Toll.
“Just relating to bilateral surgery, that relates to a death rate of 3%,” Hillier put to him.
“Yes,” Khoury responded.
According to a 2023 study of complications from total knee replacement surgeries, the risk of mortality associated with bilateral and single total knee replacement surgery in the 30 days after surgery is low, from 0.1% to 0.8%.
The court heard in the decade to November 2019, Khoury had performed more than 1,600 knee arthroplasty procedures in different hospitals. Khoury told the court that his overall death rate is within the acceptable range.
“The orthopaedic scientific literature is full of this sort of reporting … I think when you look at the scientific literature the mortality rate can vary widely but its generally accepted at one in 800 to one in 1,000,” Khoury said.
It was also put to Khoury by barrister Lorna McFee that four months after Toll’s death, a review was undertaken by the hospital of Khoury’s clinical practice, which Khoury confirmed.
“It was a serious matter, was it not?” McFee said.
Khoury agreed.
McFee also questioned Khoury as to whether he referred Toll to a cardiologist in the days after surgery after he experienced episodes of supraventricular tachycardia, or an increased heart rate.
Best practice would have been a referral to a cardiologist, McFee put it to Khoury, to which he agreed.
But the court heard there were no notes of any referral to a cardiologist by Khoury.
“I can’t recall making a referral but I think thats what I would have done,” Khoury told the court.
“I put it to you that you did not make any referral (to a cardiologist),” McFee put to him.
“I reject that proposition,” Khoury said.
Khoury was due to give evidence on Tuesday morning but he left the court shortly after arriving. His barrister told the court Khoury was no longer in the precinct, and would give evidence Wednesday instead.
The coroner previously heard Toll’s cardiology notes, including that he had hypertension and was on heart medication, was not among the paperwork provided to hospital staff upon his admission.
The court heard Toll’s heart health, combined with his age and type 2 diabetes, placed him at higher risk of venous thromboembolism, which is when blood clots occur in the veins.
The court heard the purpose of the inquest is to improve safety and prevent future deaths. Many members of Toll’s family, including his wife of 40 years Wendy, his children and a friend have been present each day of the inquest, scheduled to run until Friday. The interest in the case required a second, overflow room to be opened in the court.
Toll was in the army for 20 years, and had the knee surgery ahead of a planned overseas trip with his wife, the court heard.
“Mr Toll was much loved and his tragic death was a shock to all,” counsel assisting the coroner, Patrick Rooney, told the court on Monday.
“The effect of his loss has been profound.”
