scholarly journals Resuming elective orthopaedic services during the COVID-19 pandemic

2021 ◽  
Vol 2 (11) ◽  
pp. 951-957
Author(s):  
Rongkagorn Chuntamongkol ◽  
Rebekah Meen ◽  
Sophie Nash ◽  
Nicholas E. Ohly ◽  
Jon Clarke ◽  
...  
Keyword(s):  
Patient Selection ◽  
Orthopaedic Surgery ◽  
Selection Criteria ◽  
Standard Operating Procedure ◽  
Orthopaedic Patients ◽  
Number Of Patients ◽  
Patient Selection Criteria ◽  
American Society ◽  
A Prospective Study ◽  
American Society Of Anesthesiologists

Aims The aim of this study was to surveil whether the standard operating procedure created for the NHS Golden Jubilee sufficiently managed COVID-19 risk to allow safe resumption of elective orthopaedic surgery. Methods This was a prospective study of all elective orthopaedic patients within an elective unit running a green pathway at a COVID-19 light site. Rates of preoperative and 30-day postoperative COVID-19 symptoms or infection were examined for a period of 40 weeks. The unit resumed elective orthopaedic services on 29 June 2020 at a reduced capacity for a limited number of day-case procedures with strict patient selection criteria, increasing to full service on 29 August 2020 with no patient selection criteria. Results A total of 2,373 cases were planned in the 40-week study period. Surgery was cancelled in 59 cases, six (10.2%) of which were due to having a positive preoperative COVID-19 screening test result. Of the remaining 2,314, 996 (43%) were male and 1,318 (57%) were female. The median age was 67 years (interquartile range 59.2 to 74.6). The median American Society of Anesthesiologists grade was 2. Hip and knee arthroplasties accounted for the majority of the operations (76%). Six patients tested positive for COVID-19 preoperatively (0.25%) and 39 patients were tested for COVID-19 within 30 days after discharge, with only five patients testing positive (0.22%). Conclusion Through strict application of a COVID-19 green pathway, elective orthopaedic surgery could be safely delivered to a large number of patients with no selection criteria. Cite this article: Bone Jt Open 2021;2(11):951–957.

scholarly journals Restarting elective orthopaedic surgery as COVID-19 lockdown restrictions are reduced

2021 ◽  
Vol 2 (10) ◽  
pp. 865-870
Author(s):  
Warran Wignadasan ◽  
Abdulrahman Mohamed ◽  
Babar Kayani ◽  
Ahmed Magan ◽  
Ricci Plastow ◽  
...  
Keyword(s):  
Orthopaedic Surgery ◽  
Elective Surgery ◽  
Initial Study ◽  
Patient Perception ◽  
Specific Patient ◽  
Patient Consent ◽  
American Society ◽  
Global Threat ◽  
A Prospective Study ◽  
American Society Of Anesthesiologists

Aims The COVID-19 pandemic drastically affected elective orthopaedic services globally as routine orthopaedic activity was largely halted to combat this global threat. Our institution (University College London Hospital, UK) previously showed that during the first peak, a large proportion of patients were hesitant to be listed for their elective lower limb procedure. The aim of this study is to assess if there is a patient perception change towards having elective surgery now that we have passed the peak of the second wave of the pandemic. Methods This is a prospective study of 100 patients who were on the waiting list of a single surgeon for an elective hip or knee procedure. Baseline characteristics including age, American Society of Anesthesiologists (ASA) grade, COVID-19 risk, procedure type, and admission type were recorded. The primary outcome was patient consent to continue with their scheduled surgical procedure. Subgroup analysis was also conducted to define if any specific patient factors influenced decision to continue with surgery Results Overall, 88 patients (88%) were happy to continue with their scheduled procedure at the earliest opportunity. Patients with an ASA grade I were most likely to agree to surgery, followed by patients with ASA grades II, then those with grade III (93.3%, 88.7%, and 78.6% willingness, respectively). Patients waitlisted for an injection were least likely to consent to surgery, with just 73.7% agreeing. In all, there was a large increase in the proportion of patient willingness to continue with surgery compared to our initial study during the first wave of the pandemic. Conclusion As COVID-19 lockdown restrictions are lifted after the second peak of the pandemic, we are seeing greater willingness to continue with scheduled orthopaedic surgery, reinforcing a change in patient perception towards having elective surgery. However, we must continue with strict COVID-19 precautions in order to minimize viral transmission as we increase our elective orthopaedic services going forward. Cite this article: Bone Jt Open 2021;2(10):865–870.

scholarly journals Elective orthopaedic surgery with a designated COVID-19-free pathway results in low perioperative viral transmission rates

2020 ◽  
Vol 1 (9) ◽  
pp. 562-567 ◽  
Author(s):  
Justin S. Chang ◽  
Warran Wignadasan ◽  
Raj Pradhan ◽  
Christina Kontoghiorghe ◽  
Babar Kayani ◽  
...  
Keyword(s):  
Orthopaedic Surgery ◽  
Elective Surgery ◽  
Transmission Rate ◽  
Patient Characteristics ◽  
Viral Transmission ◽  
Transmission Rates ◽  
Orthopaedic Patients ◽  
Grade Ii ◽  
American Society ◽  
A Prospective Study

Aims The safe resumption of elective orthopaedic surgery following the peak of the COVID-19 pandemic remains a significant challenge. A number of institutions have developed a COVID-free pathway for elective surgery patients in order to minimize the risk of viral transmission. The aim of this study is to identify the perioperative viral transmission rate in elective orthopaedic patients following the restart of elective surgery. Methods This is a prospective study of 121 patients who underwent elective orthopaedic procedures through a COVID-free pathway. All patients underwent a 14-day period of self-isolation, had a negative COVID-19 test within 72 hours of surgery, and underwent surgery at a COVID-free site. Baseline patient characteristics were recorded including age, American Society of Anaesthesiologists (ASA) grade, body mass index (BMI), procedure, and admission type. Patients were contacted 14 days following discharge to determine if they had had a positive COVID-19 test (COVID-confirmed) or developed symptoms consistent with COVID-19 (COVID-19-presumed). Results The study included 74 females (61.2%) and 47 males (38.8%) with a mean age of 52.3 years ± 17.6 years (18 to 83 years). The ASA grade was grade I in 26 patients (21.5%), grade II in 70 patients (57.9%), grade III in 24 patients (19.8%), and grade IV in one patient (0.8%). A total of 18 patients (14.9%) had underlying cardiovascular disease, 17 (14.0%) had pulmonary disease, and eight (6.6%) had diabetes mellitus. No patients (0%) had a positive COVID-19 test in the postoperative period. One patient (0.8%) developed anosmia postoperatively without respiratory symptoms or a fever. The patient did not undergo a COVID-19 test and self-isolated for seven days. Her symptoms resolved within a few days. Conclusion The development of a COVID-free pathway for elective orthopaedic patients results in very low viral transmission rates. While both surgeons and patients should remain vigilant, elective surgery can be safely restarted using dedicated pathways and procedures. Cite this article: Bone Joint Open 2020;1-9:562–567.

PATIENT SELECTION CRITERIA IN THE SURGICAL TREATMENT OF VENO-OCCLUSIVE DYSFUNCTION

1999 ◽  
Vol 161 (4) ◽  
pp. 1145-1147 ◽  
Author(s):  
F. SASSO ◽  
G. GULINO ◽  
J. WEIR ◽  
A.M. VIGGIANO ◽  
E. ALCINI
Keyword(s):  
Surgical Treatment ◽  
Patient Selection ◽  
Selection Criteria ◽  
Patient Selection Criteria

scholarly journals Suggested Patient Selection Criteria for Initial Clinical Trials of Pig Kidney Xenotransplantation in the USA

2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Abhijit Jagdale ◽  
Vineeta Kumar ◽  
Douglas J. Anderson ◽  
Jayme E. Locke ◽  
Michael J. Hanaway ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Patient Selection ◽  
Selection Criteria ◽  
Pig Kidney ◽  
The Usa ◽  
Patient Selection Criteria

Effect of Intraoperative Fluid Management on Outcome after Intraabdominal Surgery

2005 ◽  
Vol 103 (1) ◽  
pp. 25-32 ◽  
Author(s):  
Vadim Nisanevich ◽  
Itamar Felsenstein ◽  
Gidon Almogy ◽  
Charles Weissman ◽  
Sharon Einav ◽  
...  
Keyword(s):  
Body Weight ◽  
Hospital Stay ◽  
Fluid Management ◽  
Postoperative Outcome ◽  
Protocol Group ◽  
Number Of Patients ◽  
Secondary Endpoints ◽  
American Society ◽  
American Society Of Anesthesiologists ◽  
The Impact

Background The debate over the correct perioperative fluid management is unresolved. Methods The impact of two intraoperative fluid regimes on postoperative outcome was prospectively evaluated in 152 patients with an American Society of Anesthesiologists physical status of I-III who were undergoing elective intraabdominal surgery. Patients were randomly assigned to receive intraoperatively either liberal (liberal protocol group [LPG], n = 75; bolus of 10 ml/kg followed by 12 ml x kg(-1) x h(-1)) or restrictive (restrictive protocol group [RPG], n = 77; 4 ml x kg(-1) x h(-1)) amounts of lactated Ringer's solution. The primary endpoint was the number of patients who died or experienced complications. The secondary endpoints included time to initial passage of flatus and feces, duration of hospital stay, and changes in body weight, hematocrit, and albumin serum concentration in the first 3 postoperative days. Results The number of patients with complications was lower in the RPG (P = 0.046). Patients in the LPG passed flatus and feces significantly later (flatus, median [range]: 4 [3-7] days in the LPG vs. 3 [2-7] days in the RPG; P < 0.001; feces: 6 [4-9] days in the LPG vs. 4 [3-9] days in the RPG; P < 0.001), and their postoperative hospital stay was significantly longer (9 [7-24] days in the LPG vs. 8 [6-21] days in the RPG; P = 0.01). Significantly larger increases in body weight were observed in the LPG compared with the RPG (P < 0.01). In the first 3 postoperative days, hematocrit and albumin concentrations were significantly higher in the RPG compared with the LPG. Conclusions In patients undergoing elective intraabdominal surgery, intraoperative use of restrictive fluid management may be advantageous because it reduces postoperative morbidity and shortens hospital stay.

Use of Strict Patient Selection Criteria to Achieve Significant Surgical Outcomes from a Low DIEP Flap Breast Reconstruction

2019 ◽  
Vol 35 (08) ◽  
pp. 622-630
Author(s):  
Han Gyu Cha ◽  
Min Kyu Kang ◽  
Hyun Ho Han ◽  
Eun Key Kim ◽  
Jin Sup Eom
Keyword(s):  
Breast Reconstruction ◽  
Ct Angiography ◽  
Patient Selection ◽  
Surgical Outcomes ◽  
Selection Criteria ◽  
Diep Flap ◽  
Complication Rates ◽  
Abdominal Scar ◽  
Significant Difference ◽  
Patient Selection Criteria

Abstract Background The low deep inferior epigastric perforator (DIEP) flap was first introduced in 2016 as it had aesthetic advantages over the conventional DIEP flap. With our experience of over 100 low DIEP flap procedures to date, we have conspicuously lowered complication rates and established more definitive criteria to select proper candidates. Methods We analyzed 103 patients who underwent breast reconstruction with the low DIEP flap at our hospital between May 2014 and June 2018. Demographics, patient selection criteria, flap specifics, surgical outcomes including postoperative complications, and the location of the abdominal scar and umbilicus were reviewed retrospectively. Results The mean patient age was 46.7 years, and the average body mass index was 23.7 kg/m2. A low DIEP with an average weight of 377 g was utilized within 6 hours 17 minutes in this cohort. There was no significant difference in the rate of venous congestion or fat necrosis compared with the conventional DIEP flap. The average distance from the pubic hairline to the abdominal scar was 0.6 cm and from the anterior superior iliac spine to the abdominal scar was −0.4 cm. The postoperative location of the umbilicus was 7.0 cm above the pubic hairline. Conclusion The low DIEP flap is not only a reliable option for a breast reconstruction but is an aesthetically superior approach with a lower abdominal scar and natural umbilicus. Patients may benefit from this technique if prudently selected by computed tomography (CT) angiography. A perforator that is larger than 1 mm in diameter and well enhanced on CT angiography from the division of the external iliac artery to the abdominal skin particularly in the intramuscular course should be selected.

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