Introduction: Surgery may cause a metabolic response leading to a diabetic state characterised by hyperglycaemia, insulin resistance and glucose intolerance. Metabolic stress may be worsened by the practice of Nulla Per Os (NPO).

Hip fracture patients are often subjected to fasting for extended periods. We hypothesise that a pre operative high carbohydrate drink permitted prior to surgery would mitigate the post operative diabetic state.

Methods: Ethical and Anaesthetic approval were obtained. 40 patients with hip fractures were enrolled over 4 months at Mayo General Hospital and were randomized to two groups. 20 were enrolled into Group A: control traditional NPO and Group B: Carbohydrate group. Data collection: Glucose and insulin serum levels were recorded regularly at: preadmission, post op and post op days 1 & 5; and weeks 2,3 & 6. Drink protocol: 800mls before midnight and 400mls on the morning of surgery. Exclusion criteria included diabetics and pregnancy. Hospital length of stay (HLOS), morbidity and readmissions were noted.

Result: Average age Group A: X Group B:Y. Hyperglycaemia post operatively noted in 70% of Group A vs 30% in Group B. Hyperinsulinaemia postoperatively noted in 75% of Group A vs 28% Group B. Group A and B had similar HLOS and post operative morbidity. However, we noted a higher readmission rate 45% in Group A.

Conclusion: Preoperative Carbohydrate loading significantly decreases post operative hyperglycemia and hyper insulinamia. This may show that converting a patient from fasted to a fed state prior to the insult of surgery prevents the patient entering a diabetic state and avoiding morbidity associated with same.

MRSA wound infection following Total joint arthroplasty is catastrophic with disastrous consequences. Our aim was to determine the prevalence and risk factors for MRSA colonization in patients presenting for orthopaedic surgery in our unit. All patients admitted to the hospital for elective arthroplasty over a four year period were included in the study. At the time of admission, a detailed questionnaire was completed by each patient. Routine nasal, throat, axilla, perineum swabs and from any pre-existing wound sites were sent for culture.

Among 2900 patients studied, 42 patients (1.4%) were positive for MRSA on admission. The prevalence of MRSA colonization in patients who were admitted directly from Nursing homes or from own home was 36.7% and 1.3% respectively. All MRSA positive patients who were admitted directly from home had at least one documented hospital admission in the preceding year and/or antibiotic administration within three months prior to admission. The risk factors identified for MRSA colonization were in risk order : Nursing home residency(p< 0.05), previous hospital admission(p< 0.05), antibiotic administration in previous three months(p< 0.05), and female gender(p< 0.01 )Statistical analysis with Chi squared test for independence p< 0.05 considered significant.

Present MRSA screening focuses on all patients being admitted for surgery, this contrasts to North American policies of screening only patients with risk factors. We would question the validity and economical reasoning of general rather than targeted screening procedures.