scholarly journals Assessing the adequacy of procedure-specific consent forms in orthopaedic surgery against current methods of operative consent

2010 ◽  
Vol 92 (3) ◽  
pp. 246-249 ◽  
Author(s):  
Andrew W Barritt ◽  
Laura Clark ◽  
Victoria Teoh ◽  
Adam MM Cohen ◽  
Paul A Gibb
Keyword(s):  
Total Knee Replacement ◽  
Knee Replacement ◽  
Orthopaedic Surgery ◽  
Knee Arthroscopy ◽  
Information Provision ◽  
Prospective Audit ◽  
Consent Forms ◽  
Total Knee ◽  
Audit Cycle ◽  
British Orthopaedic Association

INTRODUCTION This is an audit of patient understanding following their consent for orthopaedic procedures and uses information on new Orthoconsent forms endorsed by the British Orthopaedic Association as the set standard. The objectives were to: (i) assess whether patients& understanding of knee arthroscopy (KA) and total knee replacement (TKR) at the point of confirming their consent reaches the set standard; and (ii) to ascertain whether issuing procedure-specific Orthoconsent forms to patients can improve this understanding. SUBJECTS AND METHODS This was a prospective audit using questionnaires consisting of 26 (for KA) or 35 (for TKR) questions based on the appropriate Orthoconsent form in a department of orthopaedic surgery within a UK hospital. Participants were 100 patients undergoing KA and 60 patients undergoing TKR between February and July 2008. Participants were identified from sequential operating lists and all had capacity to give consent. During the first audit cycle, consent was discussed with the patient and documented on standard yellow NHS Trust approved generic consent forms. During the second audit cycle, patients were additionally supplied with the appropriate procedure-specific consent form downloaded from < www.orthoconsent.com > which they were required to read at home and sign on the morning of surgery. RESULTS Knee arthroscopy patients consented with only the standard yellow forms scored an average of 56.7%, rising to 80.5% with use of Orthoconsent forms. Similarly, total knee replacement patients& averages rose from 57.6% to 81.6%. CONCLUSIONS Providing patients with an Orthoconsent form significantly improves knowledge of their planned procedure as well as constituting a more robust means of information provision and consent documentation.

The Efficacy and Safety of Pharmacological Prophylaxis of VTE Following Elective Knee or Hip Replacement: Systematic Review and Network Meta-Analysis

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 2314-2314
Author(s):  
Ander Cohen ◽  
Drost Pieter ◽  
Nick Marchant ◽  
Stephen Mitchell ◽  
Michelle Orme ◽  
...  
Keyword(s):  
Total Knee Replacement ◽  
Total Hip Replacement ◽  
Knee Replacement ◽  
Major Bleeding ◽  
Hip Replacement ◽  
Orthopaedic Surgery ◽  
Randomised Controlled Trials ◽  
Total Hip ◽  
Total Knee ◽  
Randomised Controlled

Abstract Abstract 2314 Venous thromboembolism (VTE) collectively describes the debilitating, painful and potentially fatal conditions of deep vein thrombosis (DVT) and pulmonary embolism (PE). High-risk surgical procedures can lead to VTE, and patients undergoing major orthopaedic surgery, such as total hip or knee replacement (THR and TKR, respectively), are in the highest risk category for VTE. In the absence of anticoagulant prophylaxis the estimated incidence of DVT following orthopaedic surgery ranges from 40–60%, and the overall risk of fatal PE has been estimated to be between 0.2 and 0.9%. Thromboprophylaxis, both mechanical and pharmacological, is current standard practice for the prevention of VTE in patients undergoing orthopaedic surgery.Currently available anticoagulant therapies such as low molecular weight heparins (LMWHs), which are most commonly used, fondaparinux, and warfarin have demonstrated efficacy but have a number of limitations. LMWHs and fondaparinux require parenteral administration and warfarin has a narrow therapeutic window which is difficult to attain. Apixaban, rivaroxaban and dabigatran are new anti-coagulants for thromboprophylaxis after orthopaedic surgery and have the advantages of oral administration and no requirement for routine laboratory monitoring. We compared the efficacy and safety of apixaban versus other anti-coagulants for the prevention of VTE following total hip replacement and total knee replacement surgery. We systematically searched MEDLINE, EMBASE, the Cochrane library and CINAHL up to July 2010 for randomised controlled trials (RCTs) evaluating apixaban, rivaroxaban, dabigatran, fondaparinux and low molecular weight heparins at European licensed doses. A series of direct and indirect comparisons and a network meta-analysis (NMA) were performed where there were sufficient data for analysis, using enoxaparin as the common control. Indirect comparisons found that dabigatran 220mg od was significantly less efficacious than apixaban 2.5mg bd for the prevention of all VTE and all-cause death in THR patients (OR 2.51; 95% CI 1.50–4.21), and in TKR patients (OR 1.72; 95% CI 1.22–2.42). Rivaroxaban 10mg odwas slightly more effective than apixaban 2.5mg bd in both THR and TKR patients (OR 0.69; 95% CI 0.38–1.25, and OR 0.83; 95% CI 0.57–1.19, respectively), but the differences were not statistically significant. For the incidence of major bleeding the adjusted indirect comparison found that dabigatran 220mg od and rivaroxaban 10mg od had higher, but not statistically significant, bleeding rates compared with apixaban 2.5mg bd. Dabigatran versus apixaban: for THR patients OR 1.13; 95% CI 0.50–2.54 and for TKR patients OR 1.75; 95% CI 0.51–5.99. Rivaroxaban versus apixaban: for THR patients OR 2.48; 95%CI 0.44–13.8 and for TKR patients OR 1.86; 95% CI0.47–7.30. Trials comparing fondaparinux with enoxaparin were only available in THR patients, and for the outcomes any DVT and major bleeding. The adjusted indirect comparison found that fondaparinux 2.5mg od had higher but non-significant rates of any DVT (OR 1.29; 95% CI 0.69–2.43) and major bleeding (OR 1.22; 95% CI 0.56–2.67) compared with apixaban 2.5mg bd. The NMA showedno significant differences between the treatments for the outcomes evaluated. Apixaban, rivaroxaban and dabigatran have demonstrated similar or improved efficacy and similar safety compared with current therapies for the prevention of VTE in patients undergoing orthopaedic surgery. Apixaban may be more effective than dabigatran and similar to rivaroxaban, whilst all three have a comparable safety profile. Considering practical and economic advantages, such as the ease of oral dosing and the substantial reduction in costs related to this, these new anti-coagulants represent an appealing alternative to conventional thromboprophylaxis regimens in patients undergoing THR and TKR surgery and may improve patient compliance and standard of care.Figure 1:Pooled estimates of the results of randomised controlled trials comparing the effects of apixaban, rivaroxaban and dabigatran versus enoxaparin on; the composite of all VTE and all-cause death for patients undergoing (A) total hip replacement and (B) total knee replacement and; major bleeding for patients undergoing (C) total hip replacement and (D) total knee replacementFigure 1:. Pooled estimates of the results of randomised controlled trials comparing the effects of apixaban, rivaroxaban and dabigatran versus enoxaparin on; the composite of all VTE and all-cause death for patients undergoing (A) total hip replacement and (B) total knee replacement and; major bleeding for patients undergoing (C) total hip replacement and (D) total knee replacement Disclosures: Cohen: Pfizer Ltd: Consultancy. Pieter:Pfizer/BMS: Employment. Marchant:Pfizer Ltd: Employment. Mitchell:Pfizer Ltd: Consultancy. Orme:Pfizer Ltd: Consultancy. Simon:BMS: Employment. Sutton:Pfizer Ltd: Consultancy. Rublee:Pfizer Ltd: Employment.

scholarly journals Improving Operation Notes to Meet British Orthopaedic Association Guidelines

2009 ◽  
Vol 91 (3) ◽  
pp. 217-219 ◽  
Author(s):  
David Morgan ◽  
Noel Fisher ◽  
Aman Ahmad ◽  
Fazle Alam
Keyword(s):  
Total Knee Replacement ◽  
Knee Replacement ◽  
Good Practice ◽  
District General Hospital ◽  
Total Knee Replacements ◽  
Postoperative Flexion ◽  
Data Points ◽  
Total Knee ◽  
Operation Note ◽  
British Orthopaedic Association

INTRODUCTION Operation notes are an important part of medical records for clinical, academic and medicolegal reasons. This study audited the quality of operative note keeping for total knee replacements against the standards set by the British Orthopaedic Association (BOA). PATIENTS AND METHODS A prospective review of all patients undergoing total knee replacement at a district general hospital over 8 months. Data recorded were compared with those required by the BOA good-practice guidelines. Change in practice was implemented and the audit cycle completed. Data were statistically analysed. RESULTS A total of 129 operation notes were reviewed. There was a significant improvement in the mean number of data points recorded from 9.6 to 13.1. The least well recorded data were diagnosis, description of findings, alignment and postoperative flexion range. All had a significant improvement except description of findings. The operating surgeon writing the note improved from 56% to 67%. Detailed postoperative instructions also improved in quality. CONCLUSIONS Surgeon education and the use of a checklist produce better quality total knee replacement operation notes in line with BOA guidelines. Further improvements may be made by making the data points part of the operation note itself.

scholarly journals Incidence of Total Knee Replacement after Knee Arthroscopy over the age of 50 years.

2017 ◽  
Vol 5 (5_suppl5) ◽  
pp. 2325967117S0020
Author(s):  
Mr Tony Robinson ◽  
Ms Tracy Robertson
Keyword(s):  
Total Knee Replacement ◽  
Knee Replacement ◽  
Knee Arthroscopy ◽  
Surgical Intervention ◽  
Meniscal Tear ◽  
Total Knee Replacements ◽  
Medial Meniscal Tear ◽  
Knee Replacements ◽  
Total Knee

Objectives: This paper will look at the incidence of Total Knee Replacement in patients over the age of 50 years over an 8 year period. All patients had a symptomatic medial meniscal tear and moderate bi-compartmental osteo-arthritis. Hypothesis: Incidence of Total Knee Replacement in these patients increases with age and length of follow up. Methods: A total of 411 patients met this criteria with 357 contactable by telephone. Patients were asked regarding Total Knee Replacement and other surgical intervention. Results: Of the total of 357 patients contacted, 78 (22%) patients were referred for Total Knee Replacements over this 8 year period. Conclusion: The incidence of Total Knee Replacement correlates with age but not with follow up.

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