OP0200 PATIENTS WITH HYPERMOBILITY RELATED DISORDERS HAVE A SIGNIFICANT NUMBER OF ORTHOPAEDIC INTERVENTIONS ON MULTIPLE SITES AND AT A YOUNG AGE: DATA FROM A TERTIARY REFERRAL CENTRE

Background:Mechanisms of pain associated with joint hypermobility are poorly understood and include nociceptive pain from structural joint changes along with soft tissue injuries linked to impaired proprioception; central sensitisation associated with chronic pain and muscle weakness alongside deconditioning. Anxiety and depression are also thought to play a role in patients presenting with pain and hypermobility. We have observed an increase in the rate of orthopaedic surgical procedures undertaken in patients attending the hypermobility clinics compared to those attending the general rheumatology and chronic pain clinics. There is limited published data regarding orthopaedic interventions in patients with hypermobility related disorders especially those with confirmed genetic mutations.Objectives:We aimed to evaluate the characteristics of patients in our hypermobility cohort focusing on those who had received prior surgical intervention in order to understand the underlying mechanism behind their presentations.Methods:A retrospective review of medical records was conducted of patients attending a hypermobility clinic at our tertiary referral centre, University College London Hospital, between January 2018 and December 2018.Results:There were 350 patients (300 females, 50 males) with a mean age of 36 years (range 18-71 years). 63% had a diagnosis of Hypermobility Spectrum Disorder or Hypermobility Syndrome and 37% had a type of Ehlers-Danlos Syndromes (EDS) (hypermobile, classical, vascular or other rare type). 46 patients (13%) had documented genetic mutations. 83 patients (24%) had undergone orthopaedic interventions including 9 who had EDS with confirmed genetic mutations. 54% of patients who had surgical intervention were under the age of 40. The total number of surgical procedures in the cohort was 227 (equating to 0.6485 interventions per patient). Of those requiring operative intervention, the average number of interventions per patient was 2.73. One third of patients had surgery on two or more joint groups, including 8 patients (2%) who had surgery in four or more joint groups. Knees (24%) and hips (23%) were the most common sites for operative intervention with 9% having surgery on their shoulders. 29% of pts had significant hypermobility with a Beighton score of 7 and above but there was no correlation between Beighton score and number of surgical procedures. Only 2% of cases were referred from an orthopaedic team thereby excluding a referral bias.Conclusion:Patients with hypermobility related disorders have a significant number of orthopaedic surgical procedures on multiple sites and at a young age, with indication of mechanical pathology playing an important role in their symptoms. The Beighton score does not appear to be a reliable predictor of surgical intervention. This is not surprising given that the score only covers 5 joint areas and excludes common surgical sites such as the hips and shoulders. Early diagnosis and a holistic non-operative approach combining physiotherapy and chronic pain management is essential to reduce the need for multiple surgical procedures.References:[1]Chopra P, Tinkle B, Hamonet C, Brock I, Gompel A, Bulbena A, et al. Pain management in the Ehlers-Danlos syndromes. Am J Med Genet C Semin Med Genet [Internet]. 2017 [cited 2020 Jan 27];175(1):212–9. Available from:http://www.ncbi.nlm.nih.gov/pubmed/28186390[2]Shirley ED, Demaio M, Bodurtha J. Ehlers-danlos syndrome in orthopaedics: etiology, diagnosis, and treatment implications. Sports Health [Internet]. 2012 Sep [cited 2019 Jan 30];4(5):394–403. Available from:http://www.ncbi.nlm.nih.gov/pubmed/23016112Disclosure of Interests:None declared

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P118 Orthopaedic surgical interventions in a cohort of patients with hypermobility related disorders, compared with chronic pain syndrome patients in a tertiary referral centre

Rheumatology ◽

10.1093/rheumatology/keaa111.116 ◽

2020 ◽

Vol 59 (Supplement_2) ◽

Author(s):

Sarah Wright ◽

Puja Mehta ◽

Anisur Rahman ◽

Hanadi Kazkaz

Keyword(s):

Chronic Pain ◽

Surgical Procedures ◽

Surgical Intervention ◽

Pain Syndrome ◽

Referral Centre ◽

Beighton Score ◽

Tertiary Referral Centre ◽

Surgical Interventions ◽

Pain Syndromes ◽

Chronic Pain Syndromes

Abstract Background Mechanisms of pain associated with hypermobility are poorly understood and include nociceptive pain due to structural joint changes, neuropathic pain due to disrupted proprioception, muscle weakness and central sensitisation. The influence of anxiety and low mood is also unknown. There is limited published evidence regarding orthopaedic interventions in hypermobile patients particularly following the updated 2017 Ehlers-Danlos syndrome (EDS) classification criteria. We aimed to evaluate the characteristics of a hypermobility patient cohort who had received surgical interventions and compare these with a patient population with chronic pain syndromes. Methods A retrospective analysis of medical records was conducted of patients attending a tertiary referral centre (University College London Hospital) between January 2018 and December 2018. A hypermobility-related disorders cohort was compared with a cohort of patients with chronic pain syndrome, including fibromyalgia (but without any evidence of hypermobility). Results There were 350 patients (300 females, 50 males) in the hypermobility cohort with a mean age of 36 years (range 18-71 years) at time of clinic review. 63% had hypermobility spectrum disorder or hypermobility syndrome and 37% had EDS (hypermobile, classic, vascular and other rare types). 24% of hypermobile patients had undergone orthopaedic interventions. The Beighton score did not correlate with surgical procedures. 134 patients (121 females, 13 males) with chronic pain syndromes were identified, with a mean age of 51 years (range 26-85 years). 16% of chronic pain patients had received orthopaedic surgery. 76% of hypermobile patients who had orthopaedic interventions were under 50 years old, compared to 23% in the chronic pain cohort. The total number of surgical procedures in the hypermobility cohort was 227 (0.6485 interventions per patient) compared with 25 in the chronic pain cohort (0.1865 interventions per patient); relative risk 3.477 (95% CI 2.42-4.99; P < 0.0001, chi-squared test). 33% of hypermobile patients had surgery on two or more joint groups (including 8 patients who had surgery in four or more joint groups), whereas 95% of chronic patients had surgery on only one joint group. In the hypermobile group the knee (23%) and hips (24%) were the most common site of operative intervention; however in the chronic pain cohort the most common sites were the knee (32%), spine (20%) and shoulders (20%), with only 4% requiring hip surgery. Conclusion Patients with hypermobility have a greater number of surgical procedures at multiple joint sites and at a younger age than patients with chronic pain syndromes, suggesting that mechanical pathology (rather than pain alone) and anticipated surgical success may contribute to the need for surgical intervention. The Beighton score does not appear to be a reliable predictor of surgical intervention. Earlier diagnosis and a holistic, non-operative approach, including physiotherapy and pain management, may reduce the need for surgical procedures. Disclosures S. Wright None. P. Mehta None. A. Rahman None. H. Kazkaz None.

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Consenting patients for elective procedures during the pandemic: Are we consenting for risk of nosocomial COVID-19 infection

Journal of Perioperative Practice ◽

10.1177/17504589211045235 ◽

2021 ◽

pp. 175045892110452

Author(s):

CU Menakaya ◽

M Durand-Hill ◽

O Okereke ◽

DM Eastwood

Keyword(s):

Intensive Care Unit ◽

United Kingdom ◽

Intensive Care ◽

Surgical Procedures ◽

Surgical Patients ◽

Referral Centre ◽

Tertiary Referral ◽

Tertiary Referral Centre ◽

Risk Of Death ◽

The United Kingdom

Introduction: Nosocomial COVID-19 increases morbidity and mortality in patients undergoing surgical procedures. This study assesses the consenting process in patients admitted for surgical procedures with regard to risks of contracting nosocomial COVID-19 infection during the three lockdown periods in the United Kingdom. Methods: Retrospective review of consecutive surgical patients admitted to our tertiary referral centre for surgical procedures during the lockdown periods in the United Kingdom. Data from our hospital’s electronic theatre database cross-referenced with the online surgical operative, admission and discharge records were reviewed by three independent reviewers. Discussion: A total of 180 patients (104 males and 76 females) were studied. No patients tested positive perioperatively for COVID-19. The first lockdown had a significantly larger proportion of consultants consenting (P < 0.001). Surgeons consented patients for risk of COVID-19 infection in 34.4% of cases, COVID-19-related illness in 33.9%, inpatient Intensive Care Unit (ITU) admission secondary to COVID-19 infection and risk of death due to COVID-19 in 0.0% and risk of death secondary to inpatient COVID infection in 1.1%. Conclusion: As surgical activity continues and COVID-19 persists, surgeons should be vigilant and ensure proper documentation for consent regarding COVID-19-related complications in line with the Royal College of Surgeons of England guidelines.

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A Comprehensive Approach to Thyroid Swellings: Clinical, Sonological, Cytological and Histopathological Correlation

Otorhinolaryngology Clinics - An International Journal ◽

10.5005/jp-journals-10003-1143 ◽

2014 ◽

Vol 6 (1) ◽

pp. 5-8

Author(s):

MC Trupthi ◽

S Boobalan

Keyword(s):

Diagnostic Accuracy ◽

Predictive Value ◽

Surgical Intervention ◽

Comprehensive Approach ◽

Referral Centre ◽

Tertiary Referral ◽

Tertiary Referral Centre ◽

Female Ratio ◽

Histopathological Correlation ◽

Male To Female

ABSTRACT Objectives This study was conducted with the aim of clinicopathological evaluation of thyroid swellings. Setting Tertiary referral centre, Davangere, Karnataka, India. Design Retrospective study. Materials and methods Clinical details, sonological reports, laboratory reports were retrieved from the records for the 110 patients with thyroid swellings who were included in our study, between May 2009 and April 2013 and the data was analyzed. Cytological smears in all patients and histopathology slides in operated patients were retrieved and studied. Results The highest incidence (37.4%) of thyroid swellings were found in age group of 21 to 30 years. The youngest patient being 10 years. Females (90%) predominated in this study, male to female ratio being 1:9. Majority of patients (35%) came with complaints of swelling of duration less than 6 months. Among 110 patients, 36.36% of them were treated conservatively, out of which 7 cases (17.5%) were hyperthyroid, 10 cases (25%) were hypothyroid and 23 cases (57.5%) were euthyroid and the remaining 63.63% of them underwent surgery. Of the 110 patients subjected to FNAC, 16 patients (14.54%) were neoplastic and 94 patients (85.45%) were non-neoplastic. Upon correlation with the histopathology report, the sensitivity of FNAC was 78.57%, specificity was 91.07%, with a positive predictive value of 68.75% and negative predictive value of 94.44%. Diagnostic accuracy of FNAC is 88.50%. Conclusion FNAC and USG are valuable tools in assessing the need for surgical intervention in thyroid swellings. USG guided aspiration will further enhance the cytological yield and diagnostic accuracy. How to cite this article Santosh UP, Sunil Kumar KB, Trupthi MC, Boobalan S. A Comprehensive Approach to Thyroid Swellings: Clinical, Sonological, Cytological and Histopathological Correlation. Int J Otorhinolaryngol Clin 2014;6(1):5-8.

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