Abstract. Objective. To investigate the safety and cost-effectiveness of interscalene brachial plexus block/regional anaesthesia (ISB-RA) in patients undergoing reverse total shoulder replacement. Methods. This retrospective study included 15 patients with symptomatic rotator cuff arthropathy who underwent reverse total shoulder arthroplasty (rTSA) under ISB-RA without general anaesthesia in the beach chair position from 2010 to 2018. The mean patient age was 77 years (range 59–82 years). Patients had associated medical comorbidities: American Society of Anesthesiologists (ASA) grade 2–4. Assessed parameters were: duration of anaesthesia, intra-operative systolic blood pressure variation, sedation and vasopressor use, duration of post-operative recovery, recovery scores, length of stay, and complications. A robust cost analysis was also performed. Results. The mean (range) duration of anaesthesia was 38.66 (20–60) min. Maximum and minimum intra-operative systolic blood pressure ranges were 130–210 and 75–145 mmHg, respectively (mean [range] drop, 74.13 [33–125] mmHg). Mean (range) propofol dose was 1.74 (1–3.0) mg/kg/h. The Median (interquartile range) post-operative recovery time was 30 (20–50) min. The mean (range) postoperative recovery score (local scale, range 5–28 where lower values are superior) was 5.2 (5–8). The mean (range) length of stay was 8 (1–20 days); the two included patients with ASA grade 2 were both discharged within 24 hours. One patient with predisposing history developed pneumonia; however, there were no complications related to ISB-RA. The mean (range) cost per patient was £101.36 (£59.80-£132.20). Conclusions. Our data demonstrate that rTSA under ISB-RA is safe, cost-effective and a potentially viable alternative for patients with multiple comorbidities. Notably, patients with ASA grade 2 who underwent rTSA under ISB-RA had a reduced length of stay and were discharged within 24 hours

Background. Best practice tariff (BPT) for hip fracture was introduced in April 2010, offering financial incentive to encourage trusts to implement best practice and improve quality of care. This equates to £1335. An early indicator of a patient's outcome is the time to operation from admission, with best practice targets of <36hours as a key marker of quality. As well as being detrimental to patient experience, delays in the time to operation have clear links to increased mortality rates. Method. We performed a retrospective audit of neck of femur fracture patients from 01.01.14 for 12 months, investigating time to theatre, other BPT targets, and attainment of BPT. A cost analysis was also performed from financial data. Results. Of 471 patients, 461 operations were performed. Our median time to surgery was 24.9 hours. 140 (30%) of patients were not operated on within 36 hours. 134 of these (96%) would have met the BPT had they been operated on within the 36 hour target i.e. all other BPT targets were met. This equates to a loss of £178,890. Conclusions. We achieved time to theatre target for 70% of patients (compared to 71.7% reported nationally), which is suboptimal. A solution is to dedicate more theatre time to hip fractures on theatre lists or lengthened daily trauma lists. However, at £1200 per hour running theatre, this on its own would not be cost effective. Improved theatre utilisation by 10% can potentially save the trust £3,960,000 in a year. We have put forward plans to audit our current theatre usage, potentially improving utilisation and efficiency (e.g. planned hip fracture first on list from previous day to avoid start delay). Additionally we have introduced a “Time of breach” onto our trauma board to concentrate attention on this part of best practice. Level of Evidence. Level 3

Articular cartilage injury has a high prevalence in elite and recreational athletes. Articular cartilage repair remains a challenge due to cost effectiveness and clinical effectiveness issues. There are now several effective technologies and it is possible to return to competitive sports following many of the procedures available. The durability of repair tissue is variable and there remains extensive growth in the Scientific world. Evolving cartilage restoration technologies focus on increasing cartilage quality and quantity, while optimising surgery and rehabilitation. In UK ACI has undergone extensive cost effectiveness analysis and the in-depth review has shown that ACI is cost effective compared to microfracture. ACI is indicated for lesions >2cm sq but NICE has considered that it is not indicated for problems after microfracture. This presentation details the various options available to surgeons and examines the cost effectiveness