With the increasing demand for hip and knee replacement, and the increasing pressure to move towards routine seven-day services within the National Health Service, the trend towards weekend operating is set to increase. We aimed to determine whether planned, elective total hip and total knee replacement performed at the weekend is associated with a different 30-day mortality versus those performed between Monday and Friday. We used National Joint Registry of England, Wales, Northern Ireland and Isle of Man (NJR) linked to Office for National Statistics (ONS) data. The study dataset comprised 118,096 joint replacement episodes performed at the weekend and 1,233,882 episodes done on a weekday. The main outcome measure was 30-day all-causes mortality. We applied a survivorship analysis using a Kaplan-Meier framework to examine the 30-day cumulative mortality rate for all elective hip and knee replacements performed in England and Wales between 1st April 2003 and 31st December 2014, with Cox proportional-hazards regression models to assess for time-dependent variation and adjust for identified risk factors for mortality. For hip replacement the cumulative 30-day mortality was 0.15% (95%CI: 0.12–0.19) for patients operated on at the weekend versus 0.20% (0.19–0.21) for patients undergoing surgery during the normal working week. For knee replacement the cumulative 30-day mortality was 0.14% (0.11–0.17) for patients operated on at the weekend versus 0.18% (0.17–0.19) for patients undergoing surgery during the normal working week. The lower mortality associated with weekend operating was most apparent in the later years of the audit (2009 to 2014) and remained after adjustment for any differences in patient age, gender, American Society of Anaesthesiologist grade, surgeon seniority, surgical and anaesthetic practices, and thrombo-prophylaxis choice in weekend versus weekday operated patients. Hip and knee replacements are routinely performed on Saturdays, and to a lesser extent on Sundays, in England and Wales and are not associated with an increased risk of post-operative mortality

With the increasing demand for hip and knee replacement and move towards seven-day services, we examined whether this planned, elective surgery performed at the weekend is associated with a different 30-day mortality versus that performed between Monday and Friday. The study dataset comprised 118,096 joint replacement episodes performed at the weekend and 1,233,882 episodes done on a weekday. We used a Kaplan-Meier framework to examine the 30-day cumulative mortality rate for all elective hip and knee replacements performed in England and Wales and recorded in the NJR between 1st April 2003 and 31st December 2014, with Cox proportional-hazards regression models to assess for time-dependent variation and adjust for identified risk factors for mortality. For hip replacement the cumulative 30-day mortality was 0.15% (95%CI: 0.12–0.19) for patients operated on at the weekend versus 0.20% (0.19–0.21) for patients undergoing surgery during the normal working week. For knee replacement the cumulative 30-day mortality was 0.14% (0.11–0.17) for patients operated on at the weekend versus 0.18% (0.17–0.19) for patients undergoing surgery during the normal working week. The lower mortality associated with weekend operating was most apparent in the later years of the audit (2009 to 2014) and remained after adjustment for any differences in patient age, gender, American Society of Anaesthesiologist grade, surgeon seniority, surgical and anaesthetic practices, and thrombo-prophylaxis choice in weekend versus weekday operated patients. Routine hip and knee replacements performed at the weekend in England and Wales and are not associated with an increased risk of post-operative mortality

PURPOSE OF STUDY. We investigated the effect of weekend knee arthroplasty surgery on length of inpatient stay. METHODS. 341 consecutive patients undergoing primary total knee replacement were retrospectively identified. Of these 62 underwent surgery during the weekend. Length of inpatient stay, age, sex, pre-operative haemoglobin, ASA rating, and day of surgery were recorded. Multiple regression analysis was used to determine the effect of these preoperative factors on length of post-operative inpatient stay. RESULTS. The mean length of stay following primary knee replacement was 5.9 days, with a median 4 days (2-31). Multivariate analysis confirmed that age at operation, sex, pre-operative haemoglobin and ASA were predictive of length of stay following knee arthroplasty. The day of the operation was not predictive of length of post operative stay. DISCUSSION. The results from this study suggest age, sex, ASA and preoperative haemoglobin are predictive of inpatient hospital stay. This is consistent with previous published data. Day of surgery was not predictive of length of stay. Our results suggest that weekend knee arthroplasty surgery does not result in an increased length of inpatient stay

Transferring patient data to the care of the oncoming team is the point at which the patient is most vulnerable on their journey through the healthcare system. Effective handover is vital to protect patient safety and has become increasingly more important after introduction of shift patterns for junior doctors following the implementation of the European Working Time Directive. The aim was to assess whether the introduction of a standardised proforma and traffic light system, would improve weekend handover of patients in our orthopaedic unit. Data was collected in the form of hand written data, for 3 months, in our department. This was analysed and a standardised handover sheet and traffic light system to highlight patient priority was introduced. Following a 1 week trial, the proformas were reviewed following feedback from colleagues. A re-audit was commenced and data collected for a further 2 months. There were 108 patients handed over on weekends during the re-audit compared to the 126 in the initial audit. The handover of patient data improved across all areas, with the most improved areas in recording the patients' diagnosis (58.4% to 94.4%) and noting the results of significant or pending investigations (61.2% to 91.7%). The traffic light system improved recording the patient's condition (8.5% to 81.5%) as well as logging the urgency or frequency of patient review (25.9% to 96.8%). Standardised proformas improve patient data transferred at handover and the traffic light system allows improved prioritisation of patients, thus improving patient safety at weekends

This poster describes the separation of a pair of conjoined twins, aged 3 months. They were joined at the pelvis, shared a common hindgut and each had bladder exstrophy. The operation to separate them, done over a weekend, involved paired teams of anaesthetists, Paediatric Surgeons and Paediatric Urologists and one Orthopaedic Surgeon. The surgeons mobilised and divided the hindgut, giving one twin the distal half and the other the caecum and proximal colon. Two Urologists reconstructed the bladder exstrophies. The orthopaedic contribution was bilateral oblique pelvic osteotomy to allow midline closure, along with extensive hip releases to deal with severe flexion and abduction contractures. Both twins survived and are thriving. They have little neurological impairment in the lower limbs and therefore have great potential to walk

Background

A large number of Tendo-Achilles (TA) injuries occur during sporting activity. Typically occurring in males aged 30–50, whom occasionally undertake sporting activities, the so called ‘weekend warriors’.

Abstract. Background. Alcohol has been associated with up to 40% trauma-related deaths globally. In response to the Covid-19 pandemic, the United Kingdom (UK) entered a state of ‘lockdown’ on 23. rd. March 2020. Restrictions were most significantly eased on 1. st. June 2020, when shops and schools re-opened. This study aimed to quantify the effect of lockdown on trauma admissions specifically regarding alcohol-related trauma. Methods. All adult patients admitted as ‘trauma calls’ to a London Major Trauma Centre (MTC) during April 2018 and April 2019 (pre-lockdown; N=316), and 1. st. April – 31. st. May 2020 (lockdown; N=191) had electronic patient records (EPR) analysed. Patients’ blood alcohol level (BAC) combined with records of intoxication were used to identify alcohol-related trauma. Multiple regression analyses were performed to compare pre- and post-lockdown alcohol-related trauma admissions. Results. Alcohol-related trauma was present in a significantly higher proportion of adult trauma calls during lockdown (lockdown 60/191 (31.4%), versus pre-lockdown 62/316 (19.6%); Odds Ratio (OR 0.83, 95% CI 0.38 to 1.28, p<0.001). Lockdown was also associated with increased weekend admissions of trauma (lockdown 125/191 weekend (65.5%) vs pre-lockdown 179/316 (56.7%); OR -0.40, 95% CI -0.79 to -0.02, p=0.041). No significant difference existed between the age, gender, or mechanism between pre-lockdown and lockdown cohorts (p>0.05). Conclusion. UK lockdown was independently associated with an increased proportion of alcohol-related trauma. Furthermore, trauma admissions were increased during the weekend when staffing levels are reduced. With the possibility of multiple global ‘waves’ of Covid-19, the risk of long-term repercussions of dangerous alcohol-related behaviour must be addressed

Intimate partner violence (IPV) causes significant morbidity and its unlikely to be reported compared to other forms of gender-based violence (GBV). For early detection, understanding Orthopaedic injuries from GBV is vital. This study assesses the pattern of musculoskeletal injuries from GBV and determines the factors associated with it. It is a retrospective observational study of patients aged ≥18 years, with GBV-related acute Orthopaedic injuries. Data was reviewed from January 2021 to December 2021, including, demographic information, soft tissue and bony injuries, relationship to assailant, substance abuse and the day and time of injury. Frequencies and percentages for categorical data were analysed. Chi-square test was used to calculate association. T-test was used to compare groups for continuous & categorical variables. Multivariate analysis was conducted to find the odds ratio and a p-value <0.05 was statistically significant. 138 patients were included, the mean age at presentation being 35.02 years (SD=11). 92.75% of GBV victims were females. Most were unemployed (66.7%). 30.43% (n-42) had a soft tissue injury; superficial laceration being the most common (23.1%), flexor tendon injury (10.87%), hand abscess (5.8%), and extensor tendon injury (5.07%). 71.02 % (n=98) sustained appendicular fractures. 51.45% (n=71) sustained upper limb fractures; distal radius fractures (10.86%) and distal 3rd ulnar fractures (9,42%). 19.57% (n=27) had lower limb fractures; 7.25% (n=10) had lateral malleolus ankle fractures. 63.7% (n=80) of cases were by an intimate partner on weekends (50.73%). 62.31% occurred between 16h00 and 0h00. 41.1% (n=65) reported alcohol abuse. 63.04% had surgery. GBV likely occurs in early middle-aged females by intimate partners influenced by alcohol over the weekends between 16h00 to 0h00. Distal radius/distal 3rd ulnar fractures are the most common bony injuries. Superficial wrist laceration is the commonest soft tissue injury. These findings may assist with early detection and intervention to prevent adverse outcomes in GBV

Aims. This study describes the variation in the annual volumes of revision hip arthroplasty (RHA) undertaken by consultant surgeons nationally, and the rate of accrual of RHA and corresponding primary hip arthroplasty (PHA) volume for new consultants entering practice. Methods. National Joint Registry (NJR) data for England, Wales, Northern Ireland, and the Isle of Man were received for 84,816 RHAs and 818,979 PHAs recorded between April 2011 and December 2019. RHA data comprised all revision procedures, including first-time revisions of PHA and any subsequent re-revisions recorded in public and private healthcare organizations. Annual procedure volumes undertaken by the responsible consultant surgeon in the 12 months prior to every index procedure were determined. We identified a cohort of ‘new’ HA consultants who commenced practice from 2012 and describe their rate of accrual of PHA and RHA experience. Results. The median annual consultant RHA volume, averaged across all cases, was 21 (interquartile range (IQR) 11 to 34; range 0 to 181). Of 1,695 consultants submitting RHA cases within the study period, the top 20% of surgeons by annual volume performed 74.2% of total RHA case volume. More than half of all consultants who had ever undertaken a RHA maintained an annual volume of just one or fewer RHA, however, collectively contributed less than 3% of the total RHA case volume. Consultant PHA and RHA volumes were positively correlated. Lower-volume surgeons were more likely to undertake RHA for urgent indications (such as infection) as a proportion of their practice, and to do so on weekends and public holidays. Conclusion. The majority of RHAs were undertaken by higher-volume surgeons. There was considerable variation in RHA volumes by indication, day of the week, and between consultants nationally. The rate of accrual of RHA experience by new consultants is low, and has important implications for establishing an experienced RHA consultant workforce. Cite this article: Bone Joint J 2023;105-B(10):1060–1069

Aims. Several studies have reported that patients presenting during the evening or weekend have poorer quality healthcare. Our objective was to examine how timely surgery for patients with severe open tibial fracture varies by day and time of presentation and by type of hospital. This cohort study included patients with severe open tibial fractures from the Trauma Audit and Research Network (TARN). Methods. Provision of prompt surgery (debridement within 12 hours and soft-tissue coverage in 72 hours) was examined, using multivariate logistic regression to derive adjusted risk ratios (RRs). Time was categorized into three eight-hour intervals for each day of the week. The models were adjusted for treatment in a major trauma centre (MTC), sex, age, year of presentation, injury severity score, injury mechanism, and number of operations each patient received. Results. We studied 8,258 patients from 175 hospitals. Patients presenting during the day (08:00 to 15:59; risk ratio (RR) 1.11, 95% confidence interval (CI) 1.02 to 1.20) were more likely to receive debridement within 12 hours, and patients presenting at night (16:00 to 23:59; RR 0.56, 95% CI 0.51 to 0.62) were less likely to achieve the target; triage to a MTC had no effect. Day of presentation was associated with soft-tissue coverage within 72 hours; patients presenting on a Thursday or Friday being less likely to receive this surgery within 72 hours (Thursday RR 0.88, 95% CI 0.81 to 0.97; Friday RR 0.89, 95% CI 0.81 to 0.98), and the standard less likely to be achieved for those treated in ‘non-MTC’ hospitals (RR 0.76, 95% CI 0.70 to 0.82). Conclusion. Variations in care were observed for timely surgery for severe open tibial fractures with debridement surgery affected by time of presentation and soft-tissue coverage affected by day of presentation and type of hospital. The variation is unwarranted and highlights that there are opportunities to substantially improve the delivery and quality of care for patients with severe open tibial fracture. Cite this article: Bone Jt Open 2022;3(12):941–952

Trauma, across the United Kingdom, is managed using several software, paper based lists on Microsoft Word/Excel or Teams. There is usually poor handover or no handover in a standard format- during the on call, in the trauma meetings or in the wards. The software in the market for trauma management are not cost friendly or adaptable to local demands. The alternatives like Microsoft WORD based lists are fraught with their own problems. We endeavoured to make our trauma management effective. A Quality Improvement Project was done. The goals to achieve at end of a year were:. Daily Trauma Handover in standardised format >90%. Ward Handover in standardised format >90%. Availability of outcomes of patients in clinic >80%. Reduction of paper usage >90% at the end of six months. Availability of updated “outliers” information >90% at the weekend ward round. Documentation from the Trauma Meeting > 90%. On-Call documentation in standardised format >90%. Doctor Satisfaction >75% in terms of: ease of us;, searchability of patient; ward round experience; morning trauma meeting experience; handover experience; inter-specialty communication; reliability; daily time saving; on-call time saving; patient care/safety; overall satisfaction. We used Microsoft Sharepoint List to manage our trauma workload and have named the tool as “The List”. The List has achieved all objectives as above in one year's time, except Outlier information which was at 67% in a recent PDSA (Plan-Do-Study-Act) cycle. The survey showed excellent doctor satisfaction and 90% respondents felt that The List saved an hour or more during the on-call and also during the ward rounds. We conclude that The List is a very powerful tool making trauma meetings efficient and handover effective. It is indigenous, adaptable, safe, sustainable, cost neutral and easy to use

Determine the prevalence, etiologies, and risk factors of unplanned return to the OR (UROR) in adult orthopaedic trauma patients. Retrospective review of a trauma prospective registry from 2014 – 2019 at a Level 1 academic hospital. An UROR was defined as a patient returning to OR unexpectedly following a planned definitive surgery to either readdress the presenting diagnosis or address a complication arising from the index procedure. Univariate and multivariate logistic regression was performed comparing those patients with an UROR versus those without. A total of 1568 patients were reviewed. The rate of UROR was 9.8% (153 patients). Symptomatic implant was the leading cause of UROR (60%). Other significant UROR causes were infection (15%) and implant failure (9%). The median time between index procedure and UROR was 301 days. For the univariate and multivariate analysis, open fracture (p< 0.05), fracture complexity (p<0.01), and weekend procedure (p< 0.01) were all associated with increased risk of UROR. All other variables were not statistically significant for any associations. Those patients with an UROR for reasons other than symptomatic implants were more likely to have polyorthopaedic injuries (p < 0.05), ISS > 15 (p < 0.05), osteoporosis (p < 0.01), ICU status (p < 0.05), psychiatric history (p < 0.05), compartment syndrome (p < 0.05), neurovascular injury (p < 0.01), open fracture (p < 0.05), and fracture complexity (p < 0.05). The rate of UROR in the orthopaedic trauma patient population is 10%. Most of these cases are due to implant-related issues. UROR for reasons other than symptomatic implants tend to be polytraumatized patients with higher-energy injuries, multiple complex fractures, and associated soft tissue injuries. Future focus on improved implant development and treatments for polytraumatized patients with complex fractures is warranted to decrease a relatively high UROR rate in orthopaedic trauma

Excessive resident duty hours (RDH) are a recognized issue with implications for physician well-being and patient safety. A major component of the RDH concern is on-call duty. While considerable work has been done to reduce resident call workload, there is a paucity of research in optimizing resident call scheduling. Call coverage is scheduled manually rather than demand-based, which generally leads to over-scheduling to prevent a service gap. Machine learning (ML) has been widely applied in other industries to prevent such issues of a supply-demand mismatch. However, the healthcare field has been slow to adopt these innovations. As such, the aim of this study was to use ML models to 1) predict demand on orthopaedic surgery residents at a level I trauma centre and 2) identify variables key to demand prediction. Daily surgical handover emails over an eight year (2012-2019) period at a level I trauma centre were collected. The following data was used to calculate demand: spine call coverage, date, and number of operating rooms (ORs), traumas, admissions and consults completed. Various ML models (linear, tree-based and neural networks) were trained to predict the workload, with their results compared to the current scheduling approach. Quality of models was determined by using the area under the receiver operator curve (AUC) and accuracy of the predictions. The top ten most important variables were extracted from the most successful model. During training, the model with the highest AUC and accuracy was the multivariate adaptive regression splines (MARS) model, with an AUC of 0.78±0.03 and accuracy of 71.7%±3.1%. During testing, the model with the highest AUC and accuracy was the neural network model, with an AUC of 0.81 and accuracy of 73.7%. All models were better than the current approach, which had an AUC of 0.50 and accuracy of 50.1%. Key variables used by the neural network model were (descending order): spine call duty, year, weekday/weekend, month, and day of the week. This was the first study attempting to use ML to predict the service demand on orthopaedic surgery residents at a major level I trauma centre. Multiple ML models were shown to be more appropriate and accurate at predicting the demand on surgical residents as compared to the current scheduling approach. Future work should look to incorporate predictive models with optimization strategies to match scheduling with demand in order to improve resident well being and patient care

Background. Outcomes for patients with acute illnesses may be affected by the day of the week they present to hospital. Policy makers state this ‘weekend effect’ to be the main reason for pursuing a change in consultant weekend working patterns. However, it is uncertain whether such a phenomenon exists for elective orthopaedic surgery. This study investigated whether a ‘weekend effect’ contributed to adverse outcomes in patients undergoing elective hip and knee replacements. Methods. Retrospectively collected data was obtained from our institutions electronic patient records. Using univariate analysis, we examined potential risk factors including; Age, Sex, ASA Grade, Comorbidities, as well as the day of the week surgery was undertaken. Subsequent multivariate analyses identified covariate-adjusted risk factors, associated with prolonged hospital stays. 30-day mortality data was assessed according to the day of the week surgery was performed. Results. 892 patients underwent arthroplasty surgery from 01/09/2014 till the 31/08/2015. 457 had a total hip and 435 had a total knee replacement. 814 patients (91.3%) underwent surgery during the week, while 78 patients (8.7%) had surgery on a Saturday. There was no difference in the average Length of Stay (LOS) between groups (5.0, 2.6 versus 5.0, 3.4, p=0.95), and weekend surgery was not associated with a LOS greater than 4 days. The two variables found to be associated with a prolonged LOS were; increasing age (RR) 1.02 (95% CI: 1.01–1.03, p<0.001) and an ASA score of 2, (RR) 1.6 (95% CI: 1.15– 2.20, p=0.005). There was one death in a patient who was ASA III, and who underwent surgery on a Monday. Conclusion. There is no ‘weekend effect’ for elective orthopaedic surgery. Changes in consultant weekend working patterns are unlikely to have any effect on mortality or LOS for elective orthopaedic patients

Outcomes for patients with acute illnesses may be affected by the day of the week they present to hospital. Policy makers state this ‘weekend effect’ to be the main reason for pursuing a change in consultant weekend working patterns. However, it is uncertain whether such a phenomenon exists for elective orthopaedic surgery. This study investigated whether a ‘weekend effect’ contributed to adverse outcomes in patients undergoing elective hip and knee replacements. Retrospectively collected data was obtained from our institutions electronic patient records. Using univariate analysis, we examined potential risk factors including; Age, Sex, ASA Grade, Comorbidities, as well as the day of the week, hospital admission and surgery occurred. Subsequent multivariate analyses identified covariate- adjusted risk factors, associated with prolonged hospital stays. 30-day mortality data was assessed according to the day of the week surgery was performed. 892 patients underwent arthroplasty surgery from 01/09/2014 till the 31/08/2015. 457 patients had a total hip and 435 had a total knee replacement. 814 patients (91.3%) underwent surgery during the week, while 78 (8.7%) had surgery on a Saturday. There was no difference in the average Length of Stay (LOS) between groups (5.0, 2.6 versus 5.0, 3.4, p=0.95), and weekend surgery was not associated with a LOS greater than 4 days. The two variables found to be associated with a prolonged LOS were; increasing age (RR) 1.02 (95% CI: 1.01–1.03, p<0.001) and an ASA score of 2, (RR) 1.6 (95% CI: 1.15 − 2.20, p=0.005). There was one death in a patient who was ASA III, and who underwent surgery on a Monday. There is no ‘weekend effect’ for elective orthopaedic surgery. Changes in consultant weekend working patterns are unlikely to have any effect on mortality or LOS for elective orthopaedic patients

Introduction: Previous reports have highlighted the impact of emergent crazes such as in-line skating and micro-scooters, with attention being drawn to potential accident prevention and emergent injury patterns. A modern craze is the Harry Potter series of books. UK sales of the latest book, The Half-Blood Prince, are estimated to reach 4 million. Given the lack of horizontal velocity, height, wheels or sharp edges we were interested to investigate the impact the books had on children’s traumatic injuries. Methods & Materials: A retrospective review was undertaken of Children aged 7 to 15 attending the Emergency Department of our Level 1 trauma unit over the summer months of a 3 year period. The launch dates of the most recent two books (Order of the Phoenix and The Half-Blood prince) were identified and the admissions for these weekends were compared to surrounding summer weekends and those dates in previous years. Data were obtained from MetOffice (. www.metoffice.gov.uk. ) to establish weather conditions recorded for each of the identified weekends. This would enable us to adjust for this as a confounding variable if necessary. Results: The mean attendance for children aged 7 to 15 years for this period was 65.1 (median 66, standard deviation 13.289, standard error 2.771). For the two intervention weekends the attendance rate was 36 and 37. This represents a significant decrease in emergency department attendances on those weekends (p < 0.05). MetOffice data suggested no confounding effect of weather. Discussion & Conclusion: Harry Potter books appear to protect children from traumatic injuries. The Royal Society for the Prevention of Accidents (rospa.org.uk) is dedicated to the identification and prevention of high risk childhood activities and produce guidelines on keeping children safe. To date no research has addressed the option of ‘distraction therapy’ to prevent injuries

The October 2012 Trauma Roundup. 360. looks at: which patients die from pelvic ring fractures; monolateral distraction osteogenesis; surgical management of pelvic and peroneal blast injuries; weekend warriors at risk of going AWOL; early experience with the locking attachment plate; and fibula nailing - an alternate, and viable technique

Evaluate the complications and outcomes of off-hours spinal metastasis surgery. Retrospective analysis of a prospective collected data. Preoperative, operative and post-operative data were collected as well as the complications and Frankel score at all time checkpoints. Off-hours surgery was defined as surgery starting between 17:00 and 8:00 the following day or surgery during the weekend. p < 0 .05 was defined as statistical significance threshold. 376 patients were included with an incidence of off-hours surgery of 32%. There was an increase of neurologic complication in the off hours group. This was associated with a higher ASA score and older population group. Oddly, there was decreased operative time with off-hours surgery with no difference in bleeding and number of fusion levels. Nonetheless, there was a higher percentage of neurologic improvement with off hours surgery compared to in-hours surgery. Finally, there were no effect on patients' survival in this patient population. To our knowledge, this is the first report of the effect of off-hours surgery on complications and outcomes of spinal metastasis. Greater neurological compromise and higher age and ASA scores were associated with higher incidence of off-hours surgery. It is associated with decreased surgical time with higher percentage of neurological improvement. Finally, there is no effect of surgical timing on survival rates

Introduction: Hypothesis: Patients undergoing operations at the end of the week are disadvantaged by the lack of weekend physiotherapy. Aim: To test the hypothesis by review of a single surgeon series of patients identifying factors affecting the post-operative length of stay. Methods: A cohort of patients with OA undergoing elective primary joint replacement was identified. Data was collected for demographics, procedures undertaken and length of stay. Results: 42 patients were included in the cohort. There were 23 hip and 19 knee replacements with an average age of 73.47 years. Multivariate analysis of the data was performed to ensure that the age, pathology, ASA and days of the week were equally represented. Further analysis revealed that the main factor contributing to length of stay was the age of the patient (5.13 days if age< 75 vs. 6.33 days if olderthan 75 years). Patients having surgery at the end of the week actually had a reduced length of stay compared to those at the start of the week (5.27 vs. 6.22 days). Discussion: The day of surgery does have effect on the length of stay post op. The widespread assumption that weekend physio to mobilise patients early post op may not be well founded. It is more likely that targetting patients to encourage discharge would be a more effective use of resource

Purpose of study: This study assessed the current availability of “out of hours” MRI scans for patients who present with symptoms suggestive of cauda equina syndrome to trauma units across the United Kingdom (UK). Methods: 98 trauma units in 212 hospitals across the UK were identified. Senior house officers and registrars were questioned about the availability of emergency MRI scans after 5pm and midnight and at weekends. All units responded to the survey. Results: 88 of 98 units had an on-site MRI scanner. In 32 hospitals, an MRI scan could be obtained after 5pm. In only 27 hospitals was this possible after midnight. In 58 units (65%) of cases, consultant to consultant contact was required to arrange the scan. 67 units found it “very difficult” or “impossible” to obtain an MRI scan at the weekend producing a potential delay of 64 hours from presentation at 5pm on a Friday night to 9am on a Monday morning. Conclusions: The availability of urgent MRI scans in cases of suspected cauda equina syndrome currently represents a “postcode lottery” across the UK. This may mean that patients requiring urgent surgical decompression face a significant delay in diagnosis. Delayed or missed cases of cauda equina syndrome have huge personal, social and economic impact. On-site MRI facilities, which are available 24 hours a day for such cases are recommended in all units receiving an acute trauma on call