Introduction: The recent BOA blue book on blood conservation in elective orthopaedic surgery highlighted the need for blood saving strategies to be implemented. Perioperative management guidelines of oral anti-coagulation and anti-thrombosis medication have to date concentrated on warfarin use. Information and guidelines on aspirin usage in elective orthopaedics and its effects post operatively are limited.

Methods: Data was collected prospectively from 1936 patients who underwent 2024 primary unilateral total hip replacement in a single institution. All patients were treated with the same postoperative transfusion regime and thromboembolic prophylaxis. Preoperative medication, haemoglobin levels and patient demographics were recorded by a standard assessment. Post op transfusion requirements and haemoglobin levels were noted throughout the postoperative period.

Results: Multivariate analysis revealed that preoperative aspirin use was a significant independent predictor of postoperative transfusion requirement (p< 0.001).

Discussion: Expanding indications for the use of aspirin for primary and secondary cardiovascular disease prevention have meant that large numbers of our patients undergoing total hip replacement are concurrently taking the drug. With increasing and emerging evidence of the risks involved in blood transfusion, including vCJD transmission and immune related reactions coupled with reduced supplies of donor blood further measures to reduce transfusion requirement are needed. We recommend that in the absence of absolute contraindications to stopping aspirin therapy, it should be omitted for 1 week prior to total hip replacement.

Two Air Assault Surgical Groups (AASGs) from 16 Close Support Medical Regiment deployed to Kuwait on Operation Telic in February 2003. Each AASG was comprised of a four-table resuscitation facility, a two table FST and a twin-bedded ITU facility. An A+E Consultant and nurse, an experienced radiographer and laboratory technician with two further RGNs and CMTs provided resuscitation support. Each FST had an orthopaedic and a general surgeon, two anaesthetists and eight operating department practitioners. Further equipment consisted of a Polymobil 111 x-ray unit, a Sonosite 180 ultrasound scanner and an ISTAT gas, haematocrit and electrolyte analyser. 100 units of mixed blood were carried by each AASG.

Fifty-one surgical procedures were performed on thirty-one patients. Twenty-one of these patients were Iraqi prisoners of war or civilians. Seventeen wound debridements, five amputations, five laparotomies, four insertions of Denham pins with Thomas splintage for femoral fracture, three external fiations and one axillary artery repair formed the basis of the major cases undertaken. The first field use of activated factor 7 by the British Army was successful in the resuscitation of a patient with exsanguinating haemorrhage after an open-book (APC-III) pelvic fracture and a ruptured intrapelvic haematoma. The other cases included eleven manipulations under anaesthetic/application of plaster and four finger terminalisations.

Forward military surgery has a continued role to play on the modern fast moving battlefield. 16 Close Support Medical Regiment normally supports 16 Air Assault Brigade with its remit for out-of-area operations and SF support. Its experience on Op Telic should influence planning for future deployments.

Introduction The geographical & temporal position of surgical assets in the evacuation chain during war fighting is controversial. Manning, equipment and command issues can conflict with clinical experience and evidence as to the ideal location and configuration for Field Surgical Teams.

Method Details of casualties presenting to 2 Air Attack Surgical Groups were collected prospectively during the ground war phase of Operation Telic. Mechanism and time of injury, wound type and classification, patient demographics, times and details of treatments carried out, evacuation details and outcomes were noted for both coalition and Iraqi patients.

Results The mean time to life and limb saving surgery for coalition casualties was 4 hours, significantly shorter than during previous conflicts in the region. Air case-vac requests generated within the area of responsibility failed in all cases to move patients from point of wounding to fixed hospital assets within agreed clinical timelines.

Discussion We argue that in order to keep life and limb saving surgical resuscitation within agreed clinical guidelines Field Surgery Teams must be capable of deploying to a forward environment within the Medical Regiment organization. Manning and equipment templates used by this unit provide a template for this capability.