Joint replacement surgery has been shown to be successful in post solid organ transplantation patients. However, complication rates, revision rates, and overall mortality can be higher in this population compared to patients who have not undergone solid organ transplantation. Many transplant patients have a decreased life expectancy. Therefore, literature suggests that joint replacement surgery be offered to qualifying patients early on when symptomatic. This study compares the outcomes of patients who have undergone solid organ transplantation as well as a joint replacement to patients that have only undergone joint replacement surgery. We retrospectively gathered 42 transplant (T) patients over a ten year period, 2003–2013, that underwent a liver (21) or kidney (21) transplant as well as primary total knee arthroplasty (TKA) (23) or total hip arthroplasty (THA) (19). We then gathered 42 non-transplant (NT) patients matched for procedure, age, body mass index (BMI), American Society of Anesthesiologists (ASA) score, and age adjusted Charlson co-morbidity index (ACCI) score who only underwent TKA or THA with no transplant. We used Chi-Square, T test, and multivariate analysis to compare the two groups with regard to number of complications (NOC), readmissions at 30 and 90 days post surgery, length of stay (LOS), number of intensive care unit (ICU) admissions, and total direct cost (TDC) per hospital stay.Background
Methods
Fascia iliaca compartment block (FIB), performed in the Emergency Department (A&E) in patients presenting with femoral neck fracture, has gained increasing recognition as an adjunctive analgesic. The purpose of this study was to investigate whether FIB significantly reduced the requirement for systemic opiates in the pre-operative setting. Analgesia requirements for all patients admitted with fractured neck of femur to one unit over a four month period were gathered prospectively. 33% patients had received FIB at diagnosis in ED, dependant on the expertise of the attending physician. Morphine requirements on arrival on the ward between groups were analysed. Over a four month period 144 patients were admitted with fractured neck of femur. Over this time period, introduction of an informal educational programme in A&E increased the incidence of FIB provision at diagnosis and reduced the average amount of morphine administered. Administration of FIB reduced the average morphine requirement in A&E by 56%, when compared with those who received systemic analgesia alone (CI 0.4–3.5, p=0.014). No adverse effects were reported with FIB. Fascia Iliaca Compartment Block is a safe and effective method of providing analgesia to patients with fractured neck of femur and reduces morphine requirement.
