Outsourcing elective surgery has become increasingly commonplace to meet increasing demand from a growing & aging population. There is concern that outsourcing was influencing the nature of residual workload that was unsuitable for treatment elsewhere. This led to the impression that our unit is operating on more complex patients orthopaedic problems, ASA and Body Mass Index (BMI). By losing a disproportionate number of straightforward patients our department's outcomes, productivity and training opportunities could be adversely affected. Retrospective analysis of prospectively collected data of primary hip / knee arthroplasties between July & December for 2014(pre-outsourcing), 2015 and 2016(post-outsourcing). ANOVA, Tukey Honest Significant Difference(HSD) and Pearson's correlation used. Total of 726 primary arthroplasties were performed with an almost 50 % reduction post outsourcing. Post-outsourcing, BMI and ASA were significantly worse with a ANOVA of p=0.001 and HSD p=0.003. Length of stay increased from 5.4 days in 2014 to 6.2 days in 2015 ANOVA p< 0.001 but decreased in 2016. BMI significantly affected operating time (Pearson's r =0.12, p< 0.05) and anaesthetic time (Pearson's r =0.19, p< 0.05). ASA significantly affected length of hospital stay, p< 0.01 and operation time, p=0.007 but no effect on anaesthetic time. In conclusion, we are operating on more complex patients due to current outsourcing setup. Implications for short-term were on anaesthetic and operation time, inpatient stay and training opportunity were affected, with possible long-term implications on individual surgeon and unit outcomes (complications, patient satisfaction).
Preoperative psychological distress has been reported to predict poor outcome and patient dissatisfaction after total hip replacement (THR). We investigated this relationship in a prospective multi-centre study between January 1999 and January 2002. We recorded the Oxford Hip Score (OHS) and SF36 score preoperatively and up to five years after surgery and a global satisfaction questionnaire at five year follow up for 1039 patients. We dichotomised the patients into the mentally distressed (Mental Health Scale score - MHS <50) and the not mentally distressed (MHS (50) groups based on their pre-operative MHS of the SF36. 776 (677 not distressed and 99 distressed) out of 1039 patients were followed up at 5 years.Introduction
Methods
Most high-energy trauma to lower legs, ankles and feet result in severe crush injuries. We performed a retrospective case series study Eight patients (7M: 1F) with mean age of 28 years (range -18 -35 years) were included. Four had Grade 3 open fractures of the distal tibia and 5 had open foot fractures. Two had neurovascular injuries. Four patients had associated injuries with mean ISS of 9 (range 8-16) and a mean MESS score of 3.5 (3-7). All had undergone some form of internal and external fixation within approximately 24 hours (8 hrs to 4 days). The mean follow-up period was two years (range 1-4 years). At final follow-up patients' health was measured using SF-36 questionnaire. Six patients had their fractures healed at a mean of 4.8 months (4-9 m). Two patients had fully functional foot with occasional complaints of painful ankle. Two patients had CRPS1 undergoing treatment. Two patients are unable to walk due to chronic pain and deformity. Comparison of the SF-36 scores with the age-matched UK normal controls without foot and ankle injuries showed significantly worse scores in physical function (PF: p<0.01) and role physical (RP: p< 0.01) categories. Our surgical instinct dominates decision-making, favouring salvage rather than amputation in these young groups of patient. They gradually suffer a cocktail of crippling disease characterised by psycho-socio-economic and physical disability. Should we be depleting our resources in salvaging these complex limb injuries?
