We present the 2 year results for the first 54 patients after Selective Dorsal Rhizotomy (SDR) delivered in Bristol, concentrating on change in Reimers' migration index. Eligible patients are selected at the SDR multidisciplinary meeting. Physiotherapy assessment is performed pre-operatively and at 6, 12 and 24 months post-surgery. Data collected includes GMFCS, Gross Motor Function Measure (GMFM) 88 and Modified Ashworth score for spasticity for major lower limb muscle groups, amongst other data. Pelvic radiographs are taken pre-operatively and at 2 years post-operatively. Reimers' migration index was measured using the hospital picture archiving and communication system (PACS). The mean age was 7.2 (3.9–17.5) at the time of surgery. Pre- and post-operative pelvic radiographs were available for 30 patients (60 hips). 57% (n=34) hips showed an increase in migration percentage (mean 5.4%, range 0.1–17.5%) and 43% (n=26) hips showed a decrease (mean 4.0%, range 0–15.5%). Overall no significant difference was found in Reimers' migration index at 2 year follow up (mean increase 1.3% (95% CI −0.3–3.0), p=0.12). There was an improvement in GMFCS category (by 1 grade) for 9 patients and a worsening for 1 patient at 2 year follow up. The Modified Ashworth score for spasticity improved in all patients. There was a mean improvement of 1.7 in the hip adductors and 2.4 in the ankle plantar flexors. There was a statistically significant improvement in the GMFM 88 D and E domains of 14.7 (95% CI 11.3–18.1), p<0.0001 and 11.4 (95% CI 7.4–15.7), p<0.0001 respectively. We found no evidence that SDR leads to worsening hip subluxation at 2 year follow up. All patients had improvement in lower limb spasticity. Overall there was a statistically significant improvement in function, as shown by GMFM 88 domains for standing, walking, running and jumping.
NHS governance demands that services provided are clinically effective and safe. In the current financial climate and threats over public sector spending cuts, services offered by health care providers should also be cost-effective and profitable. Surgical specialties are often perceived as expensive with high implant costs. The aim of this audit was to cost the profit margin for foot/ankle surgery and test the accuracy of coding data collected. Theatre data between January-April 2010 was retrospectively reviewed. Equipment inventories, operation notes and radiographs were reviewed for implants used. Clinical coding data was analysed and coded separately by the surgeon for comparison. Theatre expenses were calculated and accuracy estimated. Tariff generated and patient expenses were calculated and a final profit margin revealed. Wilcoxon matched-pair testing compared hospital recorded and surgeon calculated data. 95 cases were included (51 forefoot, 5 midfoot, 6 arthroscopy, 12 hindfoot, 21 other), 65 female and 30 male patients. Theatre inventories were correct in 11% of cases. Mean inventory costs recorded were £90 and following surgeon analysis, £319. Total actual inventory cost was £30,306.23 but £8548.58 was recorded (p<0.0001). OPCS codes were deemed correct in 43% and incorrect in 57% of cases. Operation profit margin, including theatre, ward and salary costs was recorded as £158,229 but corrected profit margin with d inventories and OPCS codes was £121,584 (p=0.001).Materials and Methods
Results
