Venous Thromboembolism (VTE) is the most common complication following major joint surgery. While attention has focused on VTE following joint arthroplasty their exists a gap in the literature examining the incidence of VTE in spinal surgery; with a shortage of epidemiological data, guidelines for optimal prophylaxis are limited.

This survey, undertaken at the 2009 BASS Annual Meeting, sought to examine prevailing trends in VTE thromboprophylaxis in spinal surgery and to compare selections made by Orthopaedic and Neurosurgeons.

We developed a questionnaire based around eight clinical scenarios. Participants were asked to supply details on their speciality (orthopaedics or neurosurgery) and level of training (grade) and to select which method(s) of thromboprophylaxis they would employ for each scenario. Thirty-nine participants provided responses to the eight scenarios; complete details, including speciality and grade of those surveyed, were complied for 27 of the 39 questionnaires completed.

LMWH was the preferred pharmacological method of thromboprophylaixs selected 31% and 72% of the time by orthopaedic and neurosurgeons respectively. For each of the eight clinical scenarios LMWH and BK TEDS were selected more frequently by neurosurgeons than orthopaedic surgeons who elected to employ early mobilisation and mechanical prophylaxis. Neurosurgeons were more likely to employ more than method of thromboprophylaxis.

Thromboprophylactic selections differed between the two groups; Neurosurgeons preferred LMWH and BK TEDS whilst Early Mobilisation and Mechanical prophylaxis were the preferred methods of thromboprophylaxis amongst orthopaedic surgeons. Based on the results of this survey neurosurgeons more closely adhered to guidelines outlined by NICE/BASS.

Background: A good hospital guide published in 2006 identified high in-hospital mortality rates in fracture neck of femur patients at the University Hospitals of Leicester NHS trust. The trust was identified as the worst in the country in terms of the percentage of patients having surgery within the recommended 48 hours from admission. The problem had already been identified and a ‘Fracture Neck of femur project’ was launched in January 2006 to improve outcomes in these patients. This included the introduction of trauma coordinators and clinical aides who prepared patients for surgery, a separate fracture neck of femur ward, a discharge nurse, dedicated hip fracture lists and pre and post operative orthogeriatric input.

Aim: The aim of this study was to assess the impact of the fracture neck of femur project.

Methods: Data on admissions, time to theatre, length of stay and mortality was collected for 3400 patients admitted with fracture neck of femur between January 2003 and September 2007. Mortality rates, length of stay and time to theatre were compared before and after the introduction of the fracture neck of femur project.

Results: The length of stay reduced from 32 days to 18 days in 2007 (p< 0.01). The in-hospital mortality reduced from 16.6 % in 2003 to 10.7% in 2007 (p< 0.01). 30 day mortality showed a minor reduction from 12.4% in 2003 to 11.4% in 2007 (p=0.6). 95% of patients had surgery within 48 hours as compared to 47% in 2005–06 and 85% in 2006–07.

Conclusions: The high in-hospital mortality rates were reduced. The length of stay was also reduced by effective discharge planning. Measures to reduce time to theatre were highly successful. However, the 30 day mortality did not show a significant reduction. We conclude that in hospital mortality is not a good comparator of hospital performance. 30 day mortality would be more accurate.

Introduction: This observational study assessed the influence of obesity on operating time and duration of hospital admission following Total Knee Arthroplasty (TKA).

Materials and Methods: 263 patients who underwent 276 TKAs between 1st January and December 31st 2005 at the Glenfield General Hospital were identified from the Trent (and Wales) Arthoplasty Audit Group. Patients were grouped into three weight categories based upon BMI. We examined hospital records for 265 of the 276 procedures and compared operating time, length of hospital admission and complication rates between the three BMI groups. Patient perceived outcomes including patient satisfaction, post-operative pain and frequency of walking were compared at 1-year post TKA.

Results: Obesity did not adversely influence operating time and duration of hospital stay. The mean operating time was 82 minutes in patients with a BMI ≤ 25.0, 84 min in those with a BMI 25.1–30.0 and 88 minutes for those with a BMI> 30.0 (p=0.2). The mean hospital stay was 7.7 days in patients with a BMI ≤ 25.0, 7.2 days in the BMI 25.1–30.0 group, and 6.7 days in those with a BMI > 30.0 (p=0.8).

There were no significant differences between the three BMI groups and post-operative complications (p = 0.7), patient satisfaction (p=0.1) or pain levels (p=0.7) at 1-year post-TKA. As has been demonstrated previously, increasing BMI negatively influenced post operative walking frequency (p=0.02)

Conclusion: BMI did not influence operating time, length of stay, complication rates, post operative pain and patient satisfaction post Total Knee Arthroplasty, but was associated with decreased post operative mobility.