scholarly journals 266 The Effect of the COVID-19 Pandemic on Emergency Theatre Mortality, Time to Intervention and Length of Stay in the First Phase of National Lockdown at a District General Hospital

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
W Luo ◽  
R Limb ◽  
A Aslam ◽  
R Kattimani ◽  
D Karthikappallil ◽  
...  
Keyword(s):  
Length Of Stay ◽  
General Hospital ◽  
Postoperative Mortality ◽  
District General Hospital ◽  
Urgent Care ◽  
Fractured Neck Of Femur ◽  
Neck Of Femur ◽  
Emergency Operations ◽  
Significant Difference ◽  
The Impact

Abstract Aim This study aimed to investigate the patient population requiring emergency surgery during the first phase of lockdown due to COVID-19 in the United Kingdom and compare it to the equivalent population in the same calendar period for 2019. Thus, we aimed to evaluate the impact of the pandemic on emergency operations. Method We retrospectively reviewed patients undergoing surgery in emergency theatres at our district general hospital between March 23rd and May 11th in 2019 and 2020. Data collected included demographics (age/gender), National Confidential Enquiry into Patient Outcome and Death (NCEPOD) category and operation. The primary outcome was 90-day post-operative mortality; secondary outcomes included time to intervention and length of inpatient stay. Results 132 (2020) versus 141 (2019) patients were included with no significant difference in age (p = 0.676) nor sex (p = 0.230). There was no difference in overall 90-day postoperative mortality (p = 0.196). Notably, time to intervention was faster for NCEPOD code 3 patients in 2020 than in 2019 (p = 0.027). Time to intervention in 2020 was longer for those dying within 90 days post-operatively compared to survivors (p = 0.02). There was no difference in length of stay between the years, both overall and when conducting subgroup analyses by NCEPOD category or procedures (fractured neck of femur (p = 0.776), laparoscopies (p = 0.866), laparotomies (p = 0.252)), except for upper limb trauma (p = 0.007). Conclusions Patients were appropriately prioritised with no overall change in mortality or length of stay. A national validation audit assessing outcomes of emergency operations during these challenging times would further elucidate risks posed to surgical patients requiring urgent care.

scholarly journals O33 Outcomes of patients undergoing emergency surgery during the first phase of national lockdown in the United Kingdom due to COVID-19 pandemic: experience at a district general hospital

2021 ◽  
Vol 108 (Supplement_5) ◽  
Author(s):  
W Luo ◽  
R Limb ◽  
A Aslam ◽  
R Kattimani ◽  
D Karthikappallil ◽  
...  
Keyword(s):  
United Kingdom ◽  
Length Of Stay ◽  
General Hospital ◽  
Postoperative Mortality ◽  
District General Hospital ◽  
National Guidelines ◽  
Fractured Neck Of Femur ◽  
The United Kingdom ◽  
Significant Difference ◽  
The Impact

Abstract Introduction This study aimed to assess the impact of the COVID-19 pandemic on emergency operations during the first phase of lockdown in the United Kingdom, compared to the equivalent population in the same calendar period in 2019. Method We retrospectively reviewed patients undergoing surgery in emergency theatres at our district general hospital between March 23rd and May 11th in 2019 and 2020. Data collected included demographics, National Confidential Enquiry into Patient Outcome and Death (NCEPOD) category and procedure. The primary outcome was 90-day post-operative mortality; secondary outcomes included time to intervention and length of inpatient stay. Result 132 patients (2020) versus 141 (2019) patients were included with no significant difference in age (P = 0.676), sex (P = 0.230), or overall 90-day postoperative mortality (P = 0.196). Notably, time to intervention was faster for NCEPOD code 3 patients in 2020 than 2019 (P = 0.027). Time to intervention in 2020 was longer for those dying within 90 days post-operatively compared to survivors (P = 0.02). There was no difference in length of stay between years, both overall and when comparing subgroups by NCEPOD category or procedures (fractured neck of femur (P = 0.776), laparoscopies (P = 0.866), laparotomies (P = 0.252)), except for upper limb trauma (P = 0.007). Conclusion This study is amongst the first describing the general case mix in emergency theatres in the UK. Patient pre-operative characteristics and demographics did not change. Our data confirms patient prioritisation according to NCEPOD recommendations and streamlining of surgical services, with no difference in overall mortality, time to intervention or length of stay compared to 2019. Take-home Message At this district general hospital, patients were appropriately prioritised, and our results show adaptation of hospital practice to emerging national guidelines during the first phase of lockdown. A national validation audit assessing morbidity and mortality outcomes for all NCEPOD patients may be facilitate further understanding of risks posed to patients requiring urgent surgery during these unprecedented times.

Impact of postoperative haemoglobin on length of stay post fractured hip repair in patients with standardised perioperative management

2018 ◽  
Vol 29 (2) ◽  
pp. 172-176
Author(s):  
Siu-Wai Choi ◽  
Frankie K L Leung ◽  
Tak-Wing Lau ◽  
Gordon T C Wong
Keyword(s):  
Length Of Stay ◽  
Hospital Stay ◽  
Length Of Hospital Stay ◽  
Postoperative Recovery ◽  
Medical Complications ◽  
Fractured Neck Of Femur ◽  
Neck Of Femur ◽  
Total Length ◽  
The Impact ◽  
Postoperative Haemoglobin

Introduction: Perioperative blood transfusion is not without risk and effort should be made to limit patients’ exposure to allogeneic blood. However, there is conflicting data regarding the impact of anaemia on postoperative recovery in patients with repaired hip fractures. It is hypothesised that for a given baseline functional status and fracture type, lower postoperative haemoglobin will increase rehabilitation time and prolong total length of hospital stay. Methods: This is a retrospective study on data collected prospectively on patients entered into the Clinical Pathway aged >65 years admitted to Queen Mary Hospital (QMH) with a fractured neck of femur during 2011–2013. Potential predictor variables were analysed with linear regression with respect to total length of stay and those that reached a significance level of 0.05 were included in further analysis. Results: 1092 patients were admitted to QMH with a suspected fractured neck of femur; data from 747 patients were analysed. The fracture sites were neck of femur (50%), intertrochanteric (48%) and subtrochanteric fracture (2%). Approximately 30% of patients received blood transfusions. Of these only the development of postoperative medical complications statistically prolonged hospital stay. No relationship was seen with haemoglobin levels cut-off above and below 10 g/dl with the result remaining non-significant down to a cut-off of above and below 8 g/dl. Discussion: This study revealed that post-surgical haemoglobin level of between 8 g/dl and 10 g/dL did not have an impact on the total length of hospital stay. The development of postoperative medical complications was the only factor that prolonged the total length of stay.

scholarly journals 739 The Management and Outcomes of Patients with Fractured Neck of Femur During The COVID-19 Pandemic; A District General Hospital Experience

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
P Lancaster ◽  
S Selvarajan ◽  
K Dasari
Keyword(s):  
Hip Fracture ◽  
Length Of Stay ◽  
District General Hospital ◽  
Mortality Rates ◽  
Discharge Destination ◽  
Fractured Neck Of Femur ◽  
Neck Of Femur ◽  
Vulnerable Patients ◽  
Secondary Outcomes ◽  
The Uk

Abstract Background The UK announced a “lockdown” in response to COVID-19 on 23/03/2020, despite this NHS England did not anticipate a significant decrease in hip fracture cases. Early data from Europe had shown mortality rates of up to 30.4% in patients who develop COVID-19 and a hip fracture. Method Prospective study of patients presenting with a hip fracture between 23/03/2020 and 18/05/2020. Primary outcomes were 30-day mortality and COVID-19 status. Secondary outcomes were length of stay, discharge destination and readmission. Results 50 patients identified, mean age 82. 49 patients underwent operation, 34 (69.4%) within 48 hours of admission. 14 Patients (28%) tested positive for COVID-19 within 30 days. 30-day mortality was 10% (n = 5). 2 patients who died were COVID-19 positive. Mean length of stay was 12.3 days. 7 patients (14%) re-admitted within 30 days, 4 with COVID-19. Conclusions Despite extra strain on the hospital, we believe we achieved good outcomes for this cohort. Compared to previous NHFD data we decreased our length of stay and time to operation. 30-day mortality increased (8.4% in 2018) but we believe this to be expected in vulnerable patients during a pandemic. We hope to take lessons we have learnt during the pandemic into the post-pandemic era.

scholarly journals Impact of COVID-19 pandemic on hip fractures: the central London experience COVID-related urgent geriatric hip trauma (COUGH) study COVERT ( COVid Emergency-Related Trauma and orthopaedics) collaborative

2021 ◽  
Author(s):  
Chang Park ◽  
Kapil Sugand ◽  
Arash Aframian ◽  
Catrin Morgan ◽  
Nadia Pakroo ◽  
...  
Keyword(s):  
Best Practice ◽  
Neck Of Femur ◽  
Health Crisis ◽  
Femur Fractures ◽  
Time Period ◽  
Vulnerable Patients ◽  
Significant Difference ◽  
Usual Residence ◽  
Hip Trauma ◽  
The Impact

Abstract Introduction COVID-19 has been recognized as the unprecedented global health crisis in modern times. The purpose of this study was to assess the impact of COVID-19 on treatment of neck of femur fractures (NOFF) against the current guidelines and meeting best practice key performance indicators (KPIs) according to the National Hip Fracture Database (NHFD) in two large central London hospitals. Materials and methods A multi-center, longitudinal, retrospective, observational study of NOFF patients was performed for the first ‘golden’ month following the lockdown measures introduced in mid-March 2020. This was compared to the same time period in 2019. Results A total of 78 cases were observed. NOFFs accounted for 11% more of all acute referrals during the COVID era. There were fewer overall breaches in KPIs in time to theatre in 2020 and also for those awaiting an orthogeriatric review. Time to discharge from the trust during the pandemic was improved by 54% (p < 0.00001) but patients were 51% less likely to return to their usual residence (p = 0.007). The odds ratio was significantly higher for consultant surgeon-led operations and consultant orthogeriatric-led review in the post-COVID era. There was no significant difference in using aerosol-generating anaesthetic procedures or immortality rates between both years. Conclusion The impact of COVID-19 pandemic has not adversely affected the KPIs for the treatment of NOFF patients with significant improvement in numerous care domains. These findings may represent the efforts to ensure that these vulnerable patients are treated promptly to minimize their risks from the coronavirus.

scholarly journals 822 Lessons Learnt During the COVID-19 Pandemic on Emergency Surgical Admissions in A District General Hospital

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
K Ahn ◽  
N Khan ◽  
N Desai ◽  
M Abdu ◽  
L Hiddema ◽  
...  
Keyword(s):  
General Hospital ◽  
Public Health Intervention ◽  
District General Hospital ◽  
Lifestyle Changes ◽  
Severe Respiratory Distress ◽  
Surgical Services ◽  
Record Data ◽  
Efficacious Vaccine ◽  
Severe Respiratory Distress Syndrome ◽  
The Impact

Abstract Introduction Coronavirus disease (COVID-19) is an acute severe respiratory distress syndrome which resulted in an unprecedented impact on NHS service provision. We aimed to assess the impact of COVID-19 on general surgical services in a district general hospital. Method Electronic health care record data was retrospectively collected from 6th of April to 6th of May for both 2019 and 2020. Results Despite fewer referrals and admissions in 2020 (133 vs 177 admissions in 2019), there were more failed discharges (29 vs 17 in 2019) and higher associated costs. Higher numbers of biliary related pathologies and pancreatitis (50 in 2020 vs 25 in 2019), and fewer complaints of non-specific abdominal pain (10 in 2020 vs 22 in 2019) were observed. The use of outpatient investigations decreased by approximately 40% in 2020; however, utilisation of inpatient investigations was comparable. Conclusions Better utilisation of outpatient investigations and virtual clinic services may surmount pressures from further peaks of COVID-19. The increase in biliary related cases and pancreatitis may be consequent upon lifestyle changes during lockdown. This merits further investigation and if appropriate, public health intervention. In the absence of an efficacious vaccine, further research would be essential to streamline general surgical services based on clinical risk stratification.

scholarly journals Management of Warfarin Anticoagulation in Patients with Fractured Neck of Femur

2011 ◽  
Vol 2011 ◽  
pp. 1-5 ◽  
Author(s):  
Feras Ashouri ◽  
Wissam Al-Jundi ◽  
Akash Patel ◽  
Jitendra Mangwani
Keyword(s):  
Vitamin K ◽  
Hip Fractures ◽  
National Policy ◽  
District General Hospital ◽  
Pharmacological Therapy ◽  
Fractured Neck Of Femur ◽  
Neck Of Femur ◽  
Time To Surgery ◽  
Group A ◽  
Group B

Background. Most orthopaedic units do not have a policy for reversal of anticoagulation in patients with hip fractures. The aim of this study was to examine the current practice in a district general hospital and determine difference in the time to surgery, if any, with cessation of warfarin versus cessation and treatment with vitamin K. Methods. A retrospective review of the case notes between January 2005 and December 2008 identified 1797 patients with fracture neck of femur. Fifty seven (3.2%) patients were on warfarin at the time of admission. Patients were divided into 2 groups (A and B). Group A patients (16/57; 28%) were treated with cessation of warfarin only and group B patients (41; 72%) received pharmacological therapy in addition to stopping warfarin. Time to surgery between the two groups was compared. Results. The mean INR on admission was 2.9 (range 1.7–6.5) and prior to surgery 1.4 (range 1.0–2.1). Thirty eight patients received vitamin K only and 3 patients received fresh frozen plasma and vitamin K. The average time to surgery was 4.4 days in group A and 2.4 days in group B. The difference was statistically significant (P<.01). Conclusion. Reversal of high INR is important to avoid significant delay in surgery. There is a need for a national policy for reversing warfarin anticoagulation in patients with hip fractures requiring surgery. Vitamin K is safe and effective for anticoagulation reversal in hip fracture patients.

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