Aims. Postoperative
Aims. Day-case arthroplasty is gaining popularity in Europe. We report outcomes from the first 12 months following implementation of a day-case pathway for unicompartmental knee arthroplasty (UKA) and total hip arthroplasty (THA) in an NHS hospital. Methods. A total of 47 total hip arthroplasty (THA) and 24 unicompartmental knee arthroplasty (UKA) patients were selected for the day-case arthroplasty pathway, based on preoperative fitness and agreement to participate. Data were likewise collected for a matched control group (n = 58) who followed the standard pathway three months prior to the implementation of the day-case pathway. We report same-day discharge (SDD) success, reasons for delayed discharge, and patient-reported outcomes. Overall
Aims. The aim of this study is to assess the impact of a pilot enhanced recovery after surgery (ERAS) programme on
Aims. In-hospital
Aims. In countries with social healthcare systems, such as Canada, patients may experience long wait times and a decline in their health status prior to their operation. The aim of this study is to explore the association between long preoperative wait times (WT) and acute hospital
Abstract. Background. The European population is consistently getting older and this trend is expected to continue with fastest rise seen in those over 85 years old. As a consequence there will be more nonagenarians (over 90 years old) having lower limb arthroplasty. Objectives. To compare the
Introduction. The enhanced recovery after surgery (ERAS) concept in arthroplasty surgery has led to a reduction in postoperative
Introduction. There is a drive to reduce
Introduction. Adjusting an external fixator can be a daunting process for patients. Despite comprehensive training, patients often request supervision for the initial adjustments which may result in a prolonged hospital stay. Following the introduction of telemedicine during the pandemic we believed that this could be utilised to support patients with their fixator adjustments. A quality improvement project was implemented to assess and evaluate a change in practice from existing Face to Face support to a telemedicine format. The aim of the project was to reduce median
Aims. Elective orthopaedic services have had to adapt to significant system-wide pressures since the emergence of COVID-19 in December 2019.
Reduction of
Early mobilization within the first 12 hours (day zero) of total joint arthroplasty (TJA) has been shown to reduce
We examined the effect of age, gender, body mass index (BMI), medical co-morbidity as represented by the American Society of Anaesthesiologists (ASA) grade, social deprivation, nursing practice, surgical approach, length of incision, type of prosthesis and duration of surgery on
We examined the effect of age, gender, body mass index (BMI), medical comorbidity as represented by the American Society of Anaesthesiologists (ASA) grade, social deprivation, nursing practice, surgical approach, length of incision, type of prosthesis and duration of surgery on
Recent studies have described safe outcomes for short-stays in the hospital after total shoulder arthroplasty. The purpose of this study is to identify pre-operative and operative risk factors for hospital admissions exceeding 24 hours. The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database was queried from 2006 to 2016 for the current procedural terminology (CPT) billing code related to total shoulder arthroplasty. Patients were then grouped as either having a
Provision of prehabilitation prior to total knee arthroplasty (TKA) through a digital mobile application is a novel concept. Our research evaluates a resource effective and cost effective method of delivering prehabilitation. The primary aim of our research is to determine whether provision of prehabilitation through a mobile digital application impacts inpatient LOS after TKA. The secondary objective is to understand the effect of digital prehabilitation on hospital costs. An observational, retrospective analysis was performed on a consecutive case series of 64 patients who underwent TKA by a single surgeon over a 21 month period. Exercise provision varied from 3 months to 2 weeks prior to TKA. The outcomes of rehabilitation
This study was designed to compare
Background. The ability to identify those at risk for longer inpatient stay helps providers with postoperative planning and patient expectations. Decreasing
Introduction. Provision of prehabilitation prior to total knee arthroplasty (TKA) through a digital mobile application is a novel concept. The primary aim of our research is to determine whether provision of prehabilitation through a mobile digital application impacts
Introduction: Hypothesis: Patients undergoing operations at the end of the week are disadvantaged by the lack of weekend physiotherapy. Aim: To test the hypothesis by review of a single surgeon series of patients identifying factors affecting the post-operative
Aim: To determine the
Background. Navigated THA is a new procedure in Thailand that has been performed since 2012. The previous studies have reported that navigated THA was a safe, reliable procedure that resulted in a more consistent cup placement compared to the conventional free hand technique and decreased complications of THA, especially dislocation. Perioperative protocols are based on the surgeon's concern about stability of the prosthesis and the patient's health condition. Assuming that the navigator can improve the alignment and stability of THA, the time to start rehabilitation and the post operative
Arthroplasties are widely performed to improve mobility and quality of life for symptomatic knee/hip osteoarthritis patients. With increasing rates of Total Joint Replacements in the United Kingdom, predicting
Hip fracture patients are vulnerable to delirium. This study examined the associations between delirium and outcomes including mortality,
A prospective audit was carried out to analyse the relationship between time to surgery, number of co-morbidities and
In patients with an ankle fracture initial delay to operation because of time constraints is often prolonged because swelling precludes surgery for some days. We made use of a year long prospective audit of 2000 trauma patients to analyse the effect of delay to surgery on
Introduction. Postoperative pain is a concern for patients undergoing Total Knee Arthroplasty (TKA) and plays an important role in opioid consumption,
Single level discectomy (SLD) is one of the most commonly performed spinal surgery procedures. Two key drivers of their cost-of-care are duration of surgery (DOS) and postoperative
Introduction: Increasingly, clinical pathways and fast-track protocols are reducing hospital in-patient stay following elective joint replacement surgery. In order to improve efficiency in our unit, we undertook a prospective observational study to identify pre–and peri-operative factors associated with increased
Introduction. Social determinants of health (SDOH) may contribute markedly to the total cost of care (COC) for patients undergoing elective total knee arthroplasty (TKA). This study investigated the association between demographics, health status, and SDOH on
Aims. While interdisciplinary protocols and expedited surgical treatment improve the management of hip fractures in the elderly, the impact of such interventions on patients specifically undergoing arthroplasty for a femoral neck fracture is not clear. We sought to evaluate the efficacy of an interdisciplinary protocol for the management of patients with a femoral neck fracture who are treated with an arthroplasty. Methods. In 2017, our institution introduced a standardized interdisciplinary hip fracture protocol. We retrospectively reviewed adult patients who underwent hemiarthroplasty (HA) or total hip arthroplasty (THA) for femoral neck fracture between July 2012 and March 2020, and compared patient characteristics and outcomes between those treated before and after the introduction of the protocol. Results. A total of 157 patients were treated before the introduction of the protocol (35 (22.3%) with a THA), and 114 patients were treated after its introduction (37 (32.5%) with a THA). The demographic details and medical comorbidities were similar in the two groups. Patients treated after the introduction of the protocol had a significantly reduced median time between admission and surgery (22.8 hours (interquartile range (IQR) 18.8 to 27.7) compared with 24.8 hours (IQR 18.4 to 43.3) (p = 0.042), and a trend towards a reduced mean time to surgery (24.1 hours (SD 10.7) compared with 46.5 hours (SD 165.0); p = 0.150), indicating reduction in outliers. Patients treated after the introduction of the protocol had a significantly decreased rate of major complications (4.4% vs 17.2%; p = 0.005), decreased median hospital
Introduction: There are a number of publications in the literature on managing post-operative pain and early rehabilitation after primary total hip replacement (THR). However, there has been very little work in the literature to study the influence of the anaesthetic technique used on the post-operative
Our aim was to determine the effect of delay to surgery on the time to discharge, in-hospital death, the presence of major and minor medical complications and the incidence of pressure sores in patients with a fracture of the hip. All patients admitted to Vancouver General Hospital with this injury between 1998 and 2001 inclusive were identified from our trauma registry. A review of the case notes was performed to determine the delay in time from admission to surgery, age, gender, type of fracture and medical comorbidities. A time-to-event analysis was performed for
AIM. To evaluate patient outcomes in surgically managed ankle fractures with respect to fracture pattern, timing of surgery and
In-hospital
Introduction. The current study reports on the impact of immediate mobilization of patients treated by tissue-preserving, computer-assisted total hip arthroplasty on
Introduction: Although there are a number of publications in the literature on managing post-operative pain and early rehabilitation after surgery in general, there has been little work on the influence of anaesthetic technique on the post-operative
Abstract. Background. There is a trend towards minimising
The aim of this study was to evaluate the impact of a preoperative education programme on
Introduction. We designed this study to compare 30-day complications and
The burden of hospital
Background Hip fracture is a common clinical problem that leads to considerable morbidity and mortality in the United Kingdom. Recommendations in our hospital suggest that elderly patients suffering from these fractures should have surgery within two calendar days from admission. Methods From August 2002 to July 2003, we studied 407 patients over the age of 65 who had a fracture of the hip. (Cases were recorded prospectively in our department trauma database). This was to determine the effect of operative delay and patients age on in-hospital mortality and on post operative
Purpose: The aim of this study was to compare the results and
Introduction. Early rehabilitation and discharge following minimally-invasive total hip arthroplasty has potential risks including the possibility that patients may become progressively anemic at home. The current study assess the use of pre-emptive autologous blood transfusion on the
Many hospitals and orthopaedic surgery teams across Canada have instituted quality improvement (QI) programs for hip and knee arthroplasty. One of the common goals is to reduce hospital
Total knee and hip arthroplasty (TKA and THA) are two of the highest volume and resource intensive surgical procedures. Key drivers of the cost of surgical care are duration of surgery (DOS) and postoperative inpatient
To describe the longitudinal trends in patients with obesity and Metabolic Syndrome (MetS) undergoing TKA and the associated impact on complications and
A longer stay in the hospital after primary total hip replacement is consistent with an increased morbidity and slower recovery for patients. In addition, it is among the more costly aspects of a total joint replacement. A process, which reduces the
Introduction. With the removal of total hip arthroplasty (THA) from the Centers for Medicare & Medicaid Services (CMS) inpatient-only list, understanding predictors of
Aims. Delirium is associated with adverse outcomes following hip fracture, but the prevalence and significance of delirium for the prognosis and ongoing rehabilitation needs of patients admitted from home is less well studied. Here, we analyzed relationships between delirium in patients admitted from home with 1) mortality; 2) total
Reduced
Background. Predicting
Aim: To assess the safety and efficacy of a mini-incision surgical (MIS) approach to knee arthroplasty (TKA) compared to a traditional standard approach. Background: TKA through less invasive approaches have become increasingly popular in recent years. These range from smaller skin incisions to the ‘quadriceps-sparing’ procedures. Claims of improved recovery time and other clinical/economic advantages have been tempered by concerns about the safety of such procedures. This study was designed to evaluate any potential advantages of a specific approach (MIS) whilst studying peri-operative, radiological and outcome data to examine procedural safety. Patients and Methods: 80 patients undergoing TKA were randomised to a standard or MIS (mini-midvastus) approach. The latter involved patella subluxation, rather than eversion. The operative, anaesthetic and post-operative treatments were standardised including rehabilitation protocols. Strict discharge criteria were established and independently verified and patients were discharged directly to their homes capable of independent care. Specifically the study evaluated patient demographics, operative time, blood loss and hospital stay. Outcome data including Knee Society Scores, Oxford Knee Scores and SF36 were recorded regularly in the early recovery period and up to 1 year post-operatively. Independent radiological review of implant positioning and alignment was obtained. Results: There were no significant differences in operative time, blood loss, or other intra-operative data. Accelerated discharge was achieved in both groups (compared to historic data), however the
Our aim in this audit was to determine whether intensive rehabilitation post-operatively influenced
Currently 180 days is the target maximum wait time set by all Canadian provinces for elective joint replacement surgery. In Nova Scotia however, only 34% of Total Knee Arthroplasties (TKA) and 51% of Total Hip Arthroplasties (THA) met this benchmark in 2017. Surgery performed later in the natural history of disease is shown to have significant impact on pain, function and Health related Quality of Life at the time of surgery and potentially affect post-operative outcomes. The aim of this study is to describe the association between wait time and acute hospital
Background. Increasing number of studies investigating surgical patients have reported longer
Introduction: More than 140,000 joint replacements are carried out in England and Wales per annum costing from £4000 to £7000 each (. 1. , . 2. ). Implant costs are relatively fixed but there are considerable variations in
Introduction. In rheumatoid (RA) patients undergoing total joint arthroplasty, evidence suggests methotrexate should be continued without increase in post-operative infection. Prednisolone increases post-operative infection risk, but cannot be stopped without risk of Addisonian events. Insufficient evidence exists to clarify perioperative biologic agent management. We currently stop biologics 2 weeks prior to operation and reintroduced following wound healing. Patients/Materials & Methods. This service evaluation reviewed infection rates and
Summary: This study of 1000 patients demonstrates how you can dramatically reduce hospital
Introduction. Rapid recovery protocols (RRP) for joint replacements have been shown to improve efficiency, reduce costs, and minimize adverse outcomes in academic health systems. The purpose of this study is to evaluate if RRP can be safely implemented in a community health system for total knee arthroplasty. Methods. This study used a retrospective cohort of 3,608 patients who underwent primary unilateral total knee arthroplasty from January 1, 2013 to December 31, 2014. 60 Patients were excluded because data or surgery could not be verified: BMI less than 18.5 or greater than 60 kg/m∘2 or if the surgical time was less than 45 seconds or greater than 180 minutes, and bilateral surgery. Data was obtained from querying the health system's inpatient database containing information for all joint replacements within the system. Patients were compared in two groups: those who received a RRP after surgery versus those who received traditional post-op care. The main outcome measure was all-cause 30-day readmissions. Multivariate logistic regression was used to calculate the odds for all-cause 30-day readmission for patients who received RRP versus traditional care when controlling for age, gender, race, insurance status (Medicare versus no Medicare), obesity, diabetes, renal disease, tobacco use, and ASA score (less than 3 versus 3 or greater). Results. Patients receiving RRP were readmitted less than those who received traditional care (1.6% versus 3.6%, p<0.001) and had a lower mean
Introduction. There is no consensus on the ideal pain management strategy following total hip arthroplasty (THA). This study sought to identify immediate changes in the hospital course of patients undergoing primary THA following implementation of a rapid recovery anesthesia and multimodal management of pain (RAMP) protocol. For this study, rapid recovery anesthesia describes the use of preoperative non-narcotic medication in conjunction with neuraxial anesthesia techniques confined to the operating room only. The multimodal pain regimen consists of pre- and post-operative high dose nonsteroidal anti-inflammatories (NSAIDs), gabapentin, and antiemetics with or without intraoperative periarticular anesthetic injection. We hypothesized that the implementation of a RAMP protocol would lead to decreased reported pain scores, decreased narcotic use, and a shorter hospital stay in patients undergoing primary THA. Methods. This retrospective cohort study performed at a multi-surgeon high-volume institution reviewed the records of 81 consecutive patients who underwent primary THA utilizing traditional anesthesia and an opioid-dependentpain management techniques between June to September 2014 compared to 78 patients who underwent primary THA after implementation of the RAMP protocol between November 2014 to February 2015. The
Introduction. Given the increasing prevalence of hip and knee arthroplasties performed, measures have been implemented to standardize care and effectively improve patient outcomes and decrease costs.
Abstract. Introduction. Spinal local anaesthesia and opioids have long been used as peri-operative analgesia for patients undergoing arthroplasty procedures. However, intrathecal opioids are associated with numerous complications. ERAS. ®. society guidelines for elective knee replacement (2019) strongly discourage the use of spinal opioids. This study aims to report the impact of low-dose spinal and local infiltrative analgesia on patients undergoing elective knee replacement. Methodology. Retrospective cohort study of patients undergoing knee replacement under the ERAS protocol over 2 years, at a district general hospital under the care of a single surgeon. Results. A total of 80 knee replacements were included in the study (M38:F42, mean age=72.7, mean BMI=31, ASA: 1=8, 2=54, 3=18). 91% received neuroaxial anaesthesia, 89% without intrathecal opioids. Local infiltrative analgesia was used in 99% of patients. The mean
En bloc resection for primary bone tumours and isolated metastasis are complex surgeries associated with a high rate of adverse events (AEs). The primary objective of this study was to explore the relationship between frailty/sarcopenia and major perioperative AEs following en bloc resection for primary bone tumours or isolated metastases of the spine. Secondary objectives were to report the prevalence and distribution of frailty and sarcopenia, and determine the relationship between these factors and
Objectives. To determine whether a delay to surgery (>36Hours) affects mortality rate,
Introduction. The Rapid Recovery Program (RRP) is a holistic perioperative accelerated discharge process that aims to improve efficiency and quality of care, improve patient education, standardise protocols and pathways and encourage early mobilisation & discharge. Aims. To compare
Introduction: This study evaluates the effect on hospital
We carried out a retrospective cohort study of 3309 patients undergoing primary total hip replacement to examine the impact of tobacco use and body mass index on the
Introduction. Greater
Introduction. We conducted a study of 312 patients undergoing primary hip and knee arthroplasty in 2005. The aim was to identify the correlation between
Aims. Psychoeducative prehabilitation to optimize surgical outcomes is relatively novel in spinal fusion surgery and, like most rehabilitation treatments, they are rarely well specified. Spinal fusion patients experience anxieties perioperatively about pain and immobility, which might prolong hospital
Appropriate surgical management of hip fractures has major clinical and economic consequences. Recently IMN use has increased compared to SHS constructs, despite no clear evidence demonstrating superiority of outcome. We therefore set out to provide further evidence about the clinical and economic implications of implant choice when considering hip fracture fixation strategies. A retrospective cohort study using Scottish hip fracture audit (SHFA) data was performed for the period 2016–2022. Patients ≥50 with a hip fracture and treated with IMN or SHS constructs at Scottish Hospitals were included. Comparative analyses, including adjustment for confounders, were performed utilising Multivariable logistic regression for dichotomous outcomes and Mann-Whitney-U tests for non-parametric data. A sub-group analysis was also performed focusing on AO-A1/A2 configurations which utilised additional regional data. Cost differences in
Prolonged
The current study aims to find the role of Enhance Recovery Pathway (ERP) as a multidisciplinary approach aimed to expedite rapid recovery, reduce LOS, and minimize morbidity associated with Non Fusion Anterior Scoliosis Correction (NFASC) surgery. A retrospective analysis of 35 AIS patients who underwent NFASC with Lenke 1 and Lenke 5 curves with a minimum of 1 year of follow-up was done. Patient demographics, surgical details, postoperative analgesia, mobilization,
Hip fractures are a major cause of morbidity and mortality in the elderly and are thought to represent an increasing cohort of our patients. It is estimated that the cost of caring for each patient for their hospital admission is €10,000. There is significant regional and international variation in the incidence rates of such injuries, depending on age, sex and ethnic variations in populations. Recent Irish literature would suggest that the rates in Ireland are exponentially increasing while in the US the rate may be decreasing. The
Background. The evaluation and management of outcomes risk has become an essential element of a modern total joint replacement program. Our multidisciplinary team designed an evidence-based tool to address modifiable risk factors for adverse outcomes after primary hip and knee arthroplasty surgery. Methods. Our protocols were designed to identify, intervene, and mitigate risk through evidence-based patient optimization. Nurse navigators screened patients preoperatively, identified and treated risk factors, and followed patients for 90 days postoperatively. We compared patients participating in our optimization program (N=104) to both a historical cohort (N=193) and a contemporary cohort (N=166). Results. Risk factor identification and optimization resulted in lower hospital
The DTC approach to patient management aims to decrease waiting list times and
Introduction. Hip and knee replacements are predictable orthopaedic procedure with excellent clinical outcomes. Discharging or leaking wounds affect
Introduction: Rehabilitation of hip fracture patients is often lengthy with bed day consumption accounting for up to 85 % of the total hospitalization cost. Data suggests that patients who suffer surgical complications requiring re-operation have an excessive length of hospitalization, but the overall impact of surgical complications including those not requiring re-operations have not been examined in detail. Methods: Six hundred consecutive, unselected patients with a primary hip fracture were included between 2002 and 2004. All patients received surgery and a multimodal rehabilitation program. Surgical complications were stratified into those requiring re-operation (<
six months) and those not allowed mobilization postoperatively due to instability of the fracture. Surgical complications were audited and classified as being due to a patient fall, infection or due to a suboptimal surgical procedure, specified as suboptimal operation method, fracture reduction or implant position. Results: 19.3 % (116/600) of the admitted patients were re-operated or immobilized. Assuming that the patients with complications otherwise would have had the same
Objective: Hospital volume is a known indicator for orthopaedic adverse events in patients undergoing total hip replacement. The aim of the current study was to evaluate the effect of hospital volume on the
Aim. The aim of this study was to determine the factors which were responsible for differences between patients achieving the Trust target of discharge on post-operative day 5 after a primary total knee replacement and those not achieving it, in the cohort of over 75 year olds. Methods and Results. Of all the patients undergoing a TKR at Addenbrooke's Hospital in 2008, those over 75 were identified (n=103). From the literature pre-, intra- and post-operative factors that had previously been shown to affect
Hip fractures constitute a major cause of hospital admission and
A number of studies have reported longer
Purpose: Elective total hip and knee replacement surgeries are effective procedures for patients suffering from hip and knee disease. The demand for joint replacements is expected to rise as the life expectancy of Canadians increases; thus putting a heavy burden on healthcare. In an effort to reduce the acute hospital
Introduction: Ranked as the second most common cause of long-term disability amongst American adults, osteoarthritis (OA) affects well over 60 million Americans per year. OA is one of the major contributors to health care-related economic cost in the US, which is generally considered unacceptably high when compared other Western industrialized nations. Methods: Three hundred and thirty-five patients undergoing primary unilateral or bilateral total hip arthroplasty (THA), metal-on-metal hip resurfacing (MOMHR), total knee arthroplasty (TKA), or unicondylar knee arthroplasty (UKA) were offered voluntary participation in an one-on-one preoperative education session with a pre-operative educator.
Introduction. Many determinants of the
Surgical site infections (SSIs) are associated with significant consequences in orthopaedic surgery, where their presence can lead to ultimate revision of the implant. Furthermore, infections and impaired wound healing can prolong
Introduction: Recent studies have shown that Minimally Invasive Total Hip Replacements (MISTHRs) have not reduced hospital stay. We seek to demonstrate the importance of infrastructure allowing early mobilisation and discharge thereby gaining the full benefits of MISTHRs. We compared the early outcomes of 2 units where MISTHRs were carried out by the same surgical teams but had 2 different infrastructure set-ups. In the first unit a “Short Stay Programme” (SSP) was in place. This involved early pre-operative assessment by medical, physiotherapy and occupational therapy teams. Post-operative analgesia was augmented with the use of a pain pump administering local anaesthetic as a continuous infusion. Patients were mobilised at 4 hours after surgery and were supported in the community by an “Outreach Team”. In the second unit the patients had MISTHRs without changes to the conventional infrastructure. Methods: One surgeon carried out all operations, at 2 different hospitals using a mini-posterior approach with specific minimally-invasive instrumentation. Uncemented ABG II prostheses were used. Hospital discharge was only achieved after specific criteria were fulfilled. Discussion: A significant reduction in the
Background. The advent of value-based conscientiousness and rapid-recovery discharge pathways presents surgeons, hospitals, and payers with the challenge of providing the same total hip arthroplasty episode of care in the safest and most economic fashion for the same fee, despite patient differences. Various predictive analytic techniques have been applied to medical risk models, such as sepsis risk scores, but none have been applied or validated to the elective primary total hip arthroplasty (THA) setting for key payment-based metrics. The objective of this study was to develop and validate a predictive machine learning model using preoperative patient demographics for
This study examined the effect of seven vs. five day physiotherapy on hospital LOS for total joint replacement (TJR) patients. 1055 consecutive TJR patients were studied. Seven day PT significantly reduced LOS for TJR patients (0.73 days) and the subgroup of total hip replacement patients (0.80 days). Decreases in TJR LOS reduced hospital costs by $100,000. Older patients and patients with greater co-morbidities had a longer LOS with both five and seven day PT, but their LOS was less with seven day PT. This study provides strong evidence for providing seven day PT for TJR patients. The purpose of this study was to determine the effect of five vs. seven day/week physiotherapy (PT) on acute care,
In the current austere financial climate within the NHS where local healthcare Trusts are reimbursed in a Payment by Results system it is important that we accurately identify the costs associated with surgical procedures. We retrospectively reviewed data of 589 consecutive patients undergoing lower limb arthroplasty surgery and recorded their age, BMI and co-morbidities. The effect of these parameters on operative duration and
Background: Recent studies have shown that local infiltration analgesia (LIA) improves outcome after total hip replacement (THA). No detailed information does exist to its influence on
The health care system has to deal with substantial health care costs, which are expected to continue to rise due to the increasingly elderly populations. One way of saving has been a reduction of the amount of beds at hospitals. The consequence is that acute patients inappropriately are admitted to non specialized wards because of limited beds. These patients are also known as ‘outliers’. In this study consecutive patients with a hip fracture treated at the orthopaedic department (n=273) are compared with patients treated at other departments (n=147) according to incidence of complications and
The price per total knee replacement (TKR) performed is fixed but the subsequent
Backgroud: Allogeneic transfusion rates after primary hip and knee arthroplasty are used as quality indicators for hospitals, but hospital comparisons may be hampered by low event rates. Extended hospital stay is often used and may be more suitable as an alternative. This study aims to assess whether transfusion rates and extended hospital stay can be used to reliably rank hospitals. We used the baseline data from the LISBOA implementation trial, where data on patient characteristics and outcomes were collected in a sample of approximately 100 patients undergoing elective primary total hip or knee arthroplasty for each of the 23 participating hospitals. We calculated the reliability of ranking (Rankability) of transfusion rates and extended hospital stay (> 4 postoperative days), using fixed and random effects logistic regression analysis, by dividing the between-hospital variation to the sum of within and between-hospital variation. Rankability thus shows which part of the hospital differences are true differences and not due to random variation. 1163 total hip and 986 total knee procedures were assessed. After adjustment for patient characteristics the odds ratio (OR) of receiving a transfusion in a hospital after total hip ranged from 0.72 to 1.38 and from 0.30 to 3.30 in total knee. Rankability was 17% for hip and 36% for knee arthroplasty, meaning that only 17% and 36% are true hospital differences. Larger hospital variation was found for extended hospital stay (OR range [0.28–3.51] for hip and [0.10–9.95] for knee arthroplasty), and better rankability.Methods
Results
In Scotland, the number of primary total knee replacements performed annually has been increasing steadily. The price of the implant is fixed but the
In the polytrauma patient, intraoperative patient positioning is one factor thought to influence pulmonary complications associated with intramedullary (IM) nailing of the femur. With regards to lateral femoral nailing, it is currently unknown as to whether the position of the injured lung contributes to changes in pulmonary function. It has been proposed that, similar to prone positioning in the ICU for acute respiratory distress syndrome management, having the injured lung in a dependent position during lateral femoral nailing would prevent barotrauma from hyperinflation and promote gas exchange in the non-dependent healthy lung. This study aims to assess the association between the position of the injured lung during lateral femoral nailing and pulmonary complications as determined by ICU LOS. This retrospective cohort study was conducted at a single level 1 trauma centre. All patients treated with IM nailing for femur fracture between 2006 and 2014 were screened for inclusion. Only patients who 1) underwent lateral femoral nailing and 2) had a significant chest injury, defined by chest Abbreviated Injury Scale (AIS) of three or greater, were included. Patients with bilateral femur fractures or symmetric bilateral thoracic injuries were excluded. Intraoperative position of the lung injury was described depending on whether the injured lung was down, or in the dependent position, during lateral femoral nailing, versus the healthy lung down. The primary outcome was ICU LOS in all study patients. Secondary analysis was performed on the subgroup of patients who were admitted to ICU prior to femoral nailing. Data analysis assessing for differences in ICU LOS between groups was performed through Wilcoxan testing. One hundred and thirteen femur fractures were included in the study. During lateral femoral nailing, 53 patients had the injured lung down and 60 patients had the healthy lung down. No differences between age, ICU admission rate, injury severity score, chest AIS or head AIS were detected between the groups. There were no detectable differences in the rate of ICU admission between patients with the injured lung down (47.2%) and patients with the healthy lung down (46.7%) (P=0.96). We were unable to detect a difference in average ICU LOS between patients who had the injured lung down (4.9 days, 95% CI 2.8 – 7) compared to patients with the healthy lung down (6 days, 95% CI 3.7 – 8.4) during lateral femoral nailing (P=0.73). When looking only at patients who were admitted to ICU prior to femoral nailing, the LOS was 10.3 days (95% CI 7 – 13.7) in injured lung down patients compared to 12.9 days (9.2 – 16.6) in healthy lung down patients (P= 0.25). In patients with chest AIS greater than three, the position of the injured lung during lateral femoral IM nailing does not appear to affect ICU LOS.
Background. Patients who undergo elective hip and knee arthroplasty often have multiple risk factors increasing their likelihood of suffering from hyponatraemia post operatively. Consequently suffering from hyponatraemia post elective hip and knee arthroplasty is common. Consequently we wanted to assess the occurrence of hyponatraemia in our elective arthroplasty unit, assess our effectiveness in managing this and importantly assess how its occurrence impacted on
The ‘Best Practice Tariff‘ (BPT) was developed to improve hip fracture care by incentivising hospitals to provide timely multidisciplinary care to patients sustaining these injuries. The current literature examining the association between BPT and patient outcomes is conflicting and underpowered. We aimed to determine if achieving BPT has an impact on 30-day mortality and postoperative
Purpose. Femoral nerve block (FNB) following total knee arthroplasty (TKA) has had mixed results with some studies reporting improvement in pain and reduced narcotic exposure while others have not shown substantial differences. The effect of a FNB on rehabilitation indices (quadriceps strength, knee flexion) is also unclear. The study purpose was to compare the effect of FNB+ a multimodal analgesic protocol (MMA) to MMA only on the 1) development of a complete quadriceps motor block and 2) knee flexion during the first two postoperative days and 3) knee flexion out to 12 weeks after primary TKA. Secondarily, we compared hospital