The National Confidential Enquiry into Perioperative Deaths recommends that high-dependency (HDU) or intensive care unit (ICU) care is available following arthroplasty. In hospitals without dedicated post-operative care units, patients can be transferred to wards more rapidly, which is associated with adverse surgical outcome, increased morbidity & mortality and unplanned HDU/ICU admission. Pre-operative assessment clinics (POAC) have been demonstrated to reduce these adverse outcomes. We present an evaluation of HDU/ICU admissions and a micro-cost effectiveness evaluation of POAC and planned HDU/ICU admission in hip/knee arthroplasty. Data were obtained retrospectively for all patients undergoing hip/knee arthroplasty between 01/06/2013–30/06/2014 at North Bristol NHS Trust. n=2258 admissions were linked across coding, ICU (WardWatcher), and Myocardial Ischaemia National Audit Project databases. POAC records and patient notes were hand-searched for n=83 admissions to HDU/ICU. Cost estimates were derived from clinical coding and length-of-stay. The work was performed in STATA and registered under Trust ID 15545.Background
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