264 Intertrochantic Hip Fracture Fixation at Musgrove Park Hospital

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
R Latif ◽  
H Macdonald ◽  
A Griffith ◽  
A Kelly
Keyword(s):  
Hip Fracture ◽  
Operative Management ◽  
Fracture Type ◽  
Intramedullary Nails ◽  
Improve Accuracy ◽  
The Uk ◽  
Non Operative Management ◽  
Park Hospital ◽  
Incorrect Data ◽  
Cephalomedullary Nails

Abstract Background Hip fractures, the commonest fragility fracture in the UK, carry a 6.7% 30-day mortality. NICE-CG124 guide advises extramedullary implants for trochanteric (AO3.1A1/2) and intramedullary nails for subtrochanteric fractures. We carried out a retrospective study on the use of cephalomedullary nails (CMN) at MPH to determine compliance with CG124. Method National Hip Fracture Database (NHFD) from 2019 was reviewed. Trust records were used for fracture type, surgery, and reasons for deviation from CG124. Results 201 fractures were identified. NHFD revealed 38 A3 fractures of which 36 underwent CMN, one SHS and one non-operative management. Of 163 A1/A2 fractures, 33 received CMN and 130 CHS. Only 77% of the NHFD data was correct. Further analysis revealed 18 CMNs were used for AO1/2 injuries. All had justifiable reasons for deviation from CG124, although not documented. Conclusions There is scope to improve accuracy of NHFD data. Deviation from guidelines may be appropriate but reasons must be documented and, when appropriate, discussed with patient. Similar nationwide inaccuracy can have significant implications for research based upon NHFD data. To prevent input of incorrect data, our recommendations include: Consultant to confirm AO grade during trauma meetings Reason CMN used for AO1/2 fractures to be documented Monthly local NHFD data audit

scholarly journals Appendicitis during the COVID-19 pandemic: lessons learnt from a district general hospital

BMC Surgery ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Heather C. M. Pringle ◽  
Urszula Donigiewicz ◽  
Melissa-Rose Bennett ◽  
Eleanor Walker ◽  
George E. Fowler ◽  
...  
Keyword(s):  
Treatment Failure ◽  
Medical Records ◽  
Inflammatory Markers ◽  
Retrospective Cohort ◽  
District General Hospital ◽  
Operative Management ◽  
Open Appendicectomy ◽  
Delivery Of Healthcare ◽  
The Uk ◽  
Non Operative Management

Abstract Background The COVID-19 pandemic dramatically influenced the delivery of healthcare. In line with the UK Royal Colleges’ advice the management of acute appendicitis (AA) changed with greater consideration for non-operative management (NOM) or open appendicectomy when operative management (OM) was sought. We describe our experience of the presentation, management and outcomes for these patients to inform care for future viral pandemics. Methods This retrospective, cohort study compared patients diagnosed with AA between March and July 2019 with those during the pandemic period of March to July 2020. Medical records were reviewed to obtain demographics, inflammatory markers, imaging, severity, management, histology, length of stay (LOS) and 90-day outcomes. Results There were 149 and 125 patients in the 2019 and 2020 cohorts respectively. 14 patients (9.4%) had NOM in 2019 versus 31 (24.8%) in 2020 (p = 0.001). In the 2019 operative management (OM) group 125 patients (92.6%) had laparoscopic appendicectomy versus 65 (69.1%) in 2020. 59 patients (39.6%) had a CT in 2019 versus 70 (56%) in 2020. The median LOS was 4 days in 2019 and 3 days in 2020 (p = 0.03). Two patients in each year who received NOM had treatment failure (14.3% in 2019 and 6.5% in 2020). Three patients in 2019 who received OM had treatment failure (2.2%). Of 95 patients tested for COVID-19 all but one tested negative. Conclusion During the COVID-19 pandemic there was no observed increase in severity of AA, patients had a shorter LOS and were more likely to have imaging. NOM proportionally increased with no observed change in outcomes.

scholarly journals P61 Impact of the COVID-19 pandemic on the presentation and management of acute appendicitis: a single-centre analysis

BJS Open ◽  
2021 ◽  
Vol 5 (Supplement_1) ◽  
Author(s):  
H Pringle ◽  
U Donigiewicz ◽  
M Bennett ◽  
G F Fowler ◽  
E Walker ◽  
...  
Keyword(s):  
Acute Appendicitis ◽  
Treatment Failure ◽  
Medical Records ◽  
Operative Management ◽  
Open Appendicectomy ◽  
Single Centre ◽  
Delivery Of Healthcare ◽  
The Uk ◽  
Non Operative Management ◽  
Guide Care

Abstract Introduction The COVID-19 pandemic has influenced the delivery of healthcare. In accordance with the UK Joint Royal Colleges’ advice the management of acute appendicitis (AA) changed with greater consideration for non-operative management (NOM) or open appendicectomy where operative management (OM) s sought. Our aim is to share our experience of the presentation, management and outcomes for patients presenting to our Trust with AA to guide care for future viral pandemics. Methods This single-centre retrospective cohort study included patients diagnosed with AA in March to July 2019 compared with March to July 2020. Medical records were used to evaluate demographics, inflammatory markers, imaging, severity, management, histology, length of stay (LOS), complications and 90-day outcomes. Results There were 149 and 125 patients in the 2019 and 2020 cohort, respectively. 14 patients (9.4%) had NOM in 2019 versus 31 patients (24.8%) in 2020 (p = 0.001). In the 2019 OM group 125 patients (92.6%) had laparoscopic appendicectomy versus 69 (73.4%) in 2020. 59 patients (39.6%) had a CT in 2019 versus 70 (56%) in 2020. The median LOS was 4 days (interquartile range (IQR) 3 to 6 days) in 2019 and 3 days (IQR 2 to 5 days) in 2020 (p = 0.03). Two patients in each year who received NOM had treatment failure (14.3% in 2019 and 6.5% in 2020). Three patients in 2019 who had OM had treatment failure (2.2%). Of 95 patients tested for COVID-19 all but one was negative. Conclusion During the COVID-19 pandemic there was no observed increase in severity of AA, patients had a shorter LOS and were more likely to have imaging. NOM proportionally increased with no observed change in outcomes.

scholarly journals Ellenoldali csípőtáji törésekkel összefüggő halálozás és kockázati tényezőinek vizsgálata

2017 ◽  
Vol 158 (20) ◽  
pp. 783-790
Author(s):  
Krisztina Juhász ◽  
Imre Boncz ◽  
Péter Kanizsai ◽  
Sándor Mester ◽  
Andor Sebestyén
Keyword(s):  
Risk Factors ◽  
Hip Fracture ◽  
Cox Regression ◽  
Significant Risk ◽  
Operative Management ◽  
Aim Analysis ◽  
Kaplan Meier ◽  
Non Operative Management ◽  
Type Of Fracture ◽  
Type Of Surgery

Abstract: Introduction: There is a high mortality with not well understood risk factors after the second hip fracture. Aim: Analysis of the 30- and 365-day mortality and its risk factors in patients with contralateral hip fracture. Method: Patients with contralateral hip fracture between 01 Jan 2000 and 31 Dec 2008 were identified among those who suffered their primary hip fracture in Hungary in 2000. Risk factors as age, sex, concomitant and chronic diseases, type of fracture and surgery, surgical complications, day of admission were analyzed by logistic and Cox regression as well as Kaplan-Meier analysis. Results: There were 312 eligible patients identified with 8.3 % mortality rate at 30 and with 38,4% at 365 days respectively. Significant risk factors for the 30 day mortality were intertrochanteric type of fracture (OR: 4.722; HR: 4.129) and non operative management (OR: 7.357; HR: 6.317) while for the 365 day mortality those were older age (OR:1.070; HR:1.050) and type of surgery (OR: 0.450). Conclusion: Age, type of fracture and type of surgery proved to be risk factors. There is a need to identify further risk factors in order to develop an efficacious prevention strategy for the reduction of the mortality after the second hip fractures. Orv Hetil. 2017; 158(20): 783–790.

scholarly journals 67 Reducing Delays to Operative Management of Anti-Coagulated Patients With Hip Fractures

2020 ◽  
Vol 49 (Supplement_1) ◽  
pp. i18-i20
Author(s):  
J Ensanullah ◽  
B Shah ◽  
M Fertleman
Keyword(s):  
Hip Fracture ◽  
Hip Fractures ◽  
Heart Valves ◽  
Guideline Implementation ◽  
Operative Management ◽  
National Guidelines ◽  
Improvement Project ◽  
Before And After ◽  
Surgery Timing ◽  
The Uk

Abstract Introduction In the UK, the gold-standard treatment of a hip fracture is surgical fixation within 36 hours. Reduced delay to surgery has been shown to minimise the risk of complications. Locally, frequent delays to surgery were observed in patients taking long-term anticoagulation. There are no national guidelines regarding anticoagulation reversal and surgery timing in patients with hip fractures, and doctors are often unfamiliar with increasingly prevalent Direct Oral Anti-coagulants (DOACs). This quality improvement project aimed to reduce delays to surgery in anti-coagulated patients with hip fractures. Methods A guideline was formulated following literature review and consultation with a Consultant Ortho-geriatrician, Orthopaedic Surgeon and Haematologist. Retrospective casenote audit was conducted including 3-month period before and after implementation. The new guideline was disseminated in poster form. Due to the observation that delays in receiving INR results resulted in reversal delay, patient’s on warfarin were recommended to receive 5 mg IV Vitamin K prior to receiving INR results. The INR was rechecked after 6 hours, and if less than 1.6, surgery could proceed. Those on DOACs could undergo surgery 24 hours after the last dose providing eGFR >30, and after 48 hours if eGFR <30. Exclusions were those anti-coagulated for metallic heart valves or recent venous thromboembolism. Results In the 3 months prior to guideline implementation, 71 patients had a hip fracture; 15 were anti-coagulated. Of these, 8 patients were delayed due to their anticoagulation. Repeat audit after implementation, included 46 patients with a hip fracture over the 3-month period; 7 were anti-coagulated. None were delayed due to anticoagulation (p < 0.05). Conclusions This improvement project describes formulation of a simple protocol with evidence from the literature and local expert opinion in order to reduce unnecessary delays in anti-coagulated patients with hip fractures.

scholarly journals Appendicitis During the COVID-19 Pandemic: Lessons Learnt From a District General Hospital

2021 ◽  
Author(s):  
Heather Caroline Mitchell Pringle ◽  
Urszula Donigiewicz ◽  
Melissa-Rose Bennett ◽  
Eleanor Walker ◽  
George Fowler ◽  
...  
Keyword(s):  
Treatment Failure ◽  
Medical Records ◽  
Inflammatory Markers ◽  
Retrospective Cohort ◽  
District General Hospital ◽  
Operative Management ◽  
Open Appendicectomy ◽  
Delivery Of Healthcare ◽  
The Uk ◽  
Non Operative Management

Abstract BackgroundThe COVID-19 pandemic dramatically influenced the delivery of healthcare. In line with the UK Royal Colleges’ advice the management of acute appendicitis (AA) changed with greater consideration for non-operative management (NOM) or open appendicectomy when operative management (OM) was sought. We describe our experience of the presentation, management and outcomes for these patients to inform care for future viral pandemics. MethodsThis retrospective, cohort study compared patients diagnosed with AA between March and July 2019 with those during the pandemic period of March to July 2020. Medical records were reviewed to obtain demographics, inflammatory markers, imaging, severity, management, histology, length of stay (LOS) and 90-day outcomes. ResultsThere were 149 and 125 patients in the 2019 and 2020 cohorts respectively. 14 patients (9.4%) had NOM in 2019 versus 31 (24.8%) in 2020 (p = 0.001). In the 2019 operative management (OM) group 125 patients (92.6%) had laparoscopic appendicectomy versus 65 (69.1%) in 2020. 59 patients (39.6%) had a CT in 2019 versus 70 (56%) in 2020. The median LOS was 4 days in 2019 and 3 days in 2020 (p=0.03). Two patients in each year who received NOM had treatment failure (14.3% in 2019 and 6.5% in 2020). Three patients in 2019 who received OM had treatment failure (2.2%). Of 95 patients tested for COVID-19 all but one tested negative.ConclusionDuring the COVID-19 pandemic there was no observed increase in severity of AA, patients had a shorter LOS and were more likely to have imaging. NOM proportionally increased with no observed change in outcomes.

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