There is growing clinical and policy emphasis on minimizing transfusion use in elective joint arthroplasty, but little is known about the degree to which transfusion rates vary across US hospitals. This study aimed to assess hospital-level variation in use of allogeneic blood transfusion in patients undergoing elective joint arthroplasty, and to characterize the extent to which variability is attributable to differences in patient and hospital characteristics. The study population included 228,316 patients undergoing total knee arthroplasty (TKA) at 922 hospitals and 88,081 patients undergoing total hip arthroplasty (THA) at 606 hospitals from January 1, 2009, to December 31, 2011, in the Nationwide Inpatient Sample database, a 20% stratified sample of US community hospitals.Background
Methods
Childhood obesity is an epidemic of growing concern. There has been a dramatic increase in childhood obesity in the United Kingdom in the recent years. Previous studies demonstrated that this cohort of paediatric population demonstrated poorer balance with increased risk of falling during daily activities and with weight related increase in force, more likely to sustain a fracture. The goal of present investigation is to assess the incidence of fractures in paediatric population and if there is a role of socio economic status as a confounding factor. We prospectively looked at attendance of children at out-patient fracture clinics over a period of 8 months. The BMI is calculated and the centiles are determined on the charts using Cole’s LMS method which adjusts body mass index distribution for different degrees of skew ness at different ages. Children over 98 centile were considered as obese. The musculoskeletal injuries were documented. The social status was determined from the areas where they lived using the Neighbourhood Renewal Fund. A total of 405 children presenting to the trauma clinics with musculoskeletal injuries were measured. There were 252 boys and 153 girls. The mean age is 10.5 years with a median age of 12 years (range 2–16 years). The prevalence of obesity is 14.8% compared to the national average of 13.6%. Children from deprived areas had an increased prevalence of 17.3%. The incidence of fractures remains equal in obese and normal weight children. The most common anatomical region involved is wrist and hand. Upper limb injuries were significantly more common in the obese group (p<
0.05, Chi-square test) Parents should be educated regarding the adverse effects of obesity. Strategies should be in place to identify high risk groups. Local programmes should be developed involving parents, schools authorities and health services to provide targeted care and necessary education.
