The purpose of this study was (1) to evaluate the adequacy of informed consent documentation in the trauma setting for distal radius fracture surgery compared with the elective setting for total knee arthroplasty (TKA) at a large public hospital and (2) to explore the relevant guidelines in New Zealand relating to consent documentation. Consecutive adult patients (≥16 years) undergoing operations for distal radius fractures and elective TKA over a 12-month period in a single-centre were retrospectively identified. All medical records were reviewed for the risks and complications recorded. The consent form was analysed using the Flesch Reading Ease Score (FRES) and the Simple Measure of Gobbledygook (SMOG) index readability scores. A total of 133 patients undergoing 134 operations for 135 distal radius fractures and 239 patients undergoing 247 TKA were included. Specific risks of surgery were recorded significantly less frequently for distal radius fractures than TKA (43.3% versus 78.5%, P < 0.001). Significantly fewer risks were recorded in the trauma setting compared to the elective (2.35 ± 2.98 versus 4.95 ± 3.33, P < 0.001). The readability of the consent form was 40.5 using the FRES and 10.9 using the SMOG index, indicating a university undergraduate level of reading. This study has shown poor compliance in documenting risks of surgery during the informed consent process in an acute trauma setting compared to elective arthroplasty. Institutions must prioritise improving documentation of informed consent for orthopaedic trauma patients to ensure a patient-centred approach to healthcare.
This study addresses four questions: Does laminar flow exist in our operating theatres? Do perioperative warming blankets affect laminar flow? Do perioperative warming blankets cause displacement of particles into a wound perioperatively? Do conventional theatres have adequate airflow? It has been widely recognised that laminar flow theatres decrease colony forming units in operating theatres and thus decrease the risk of infection in arthroplasty surgery. It is also accepted that perioperative warming blankets improve patient haemodynamic stability and may reduce the risk of wound infection. However, there has been great debate as to whether these perioperative warming blankets cause disruption of laminar flow and excess displacement of dust into a wound, and thus increase the risk of infection of total joint arthroplasty surgery. Using digital video imaging and airflow measurement techniques as used in formula 1 racing design, this independent study reveals that the Bair Hugger system has no effect on laminar flow or paticle displacement. It also shows that factors out of the surgeon’s control disrupt laminar flow and that general theatre design may be inherently flawed. This would seriously affect the risk of infection.
