Is Frailty Associated with Adverse Outcomes After Orthopaedic Surgery?

JBJS Reviews ◽  
2021 ◽  
Vol 9 (12) ◽  
Author(s):  
Jacie L. Lemos ◽  
Jessica M. Welch ◽  
Michelle Xiao ◽  
Lauren M. Shapiro ◽  
Ehsan Adeli ◽  
...  
Keyword(s):  
Orthopaedic Surgery ◽  
Adverse Outcomes

scholarly journals An audit of consent for allograft use in elective orthopaedic surgery

2016 ◽  
Vol 98 (04) ◽  
pp. 254-257 ◽  
Author(s):  
CJ Mullan ◽  
R Pagoti ◽  
H Davison ◽  
MG McAlinden
Keyword(s):  
Informed Consent ◽  
Disease Transmission ◽  
Orthopaedic Surgery ◽  
High Volume ◽  
General Medical Council ◽  
Adverse Outcomes ◽  
Audit And Feedback ◽  
Medical Council ◽  
Patient Consent ◽  
Arthroplasty Surgery

Introduction Patients receiving musculoskeletal allografts may be at risk of postoperative infection. The General Medical Council guidelines on consent highlight the importance of providing patients with the information they want or need on any proposed investigation or treatment, including any potential adverse outcomes. With the increased cost of defending medicolegal claims, it is paramount that adequate, clear informed patient consent be documented. Methods We retrospectively examined the patterns of informed consent for allograft bone use during elective orthopaedic procedures in a large unit with an onsite bone bank. The initial audit included patients operated over the course of 1 year. Following a feedback session, a re-audit was performed to identify improvements in practice. Results The case mix of both studies was very similar. Revision hip arthroplasty surgery constituted the major subgroup requiring allograft (48%), followed by foot and ankle surgery (16.3%) and revision knee arthroplasty surgery (11.4%) .On the initial audit, 17/45 cases (38%) had either adequate preoperative documentation of the outpatient discussion or an appropriately completed consent form on the planned use of allograft. On the re-audit, 44/78 cases (56%) had adequate pre-operative documentation. There was little correlation between how frequently a surgeon used allograft and the adequacy of consent (Correlation coefficient -0.12). Conclusions Although the risk of disease transmission with allograft may be variable, informed consent for allograft should be a routine part of preoperative discussions in elective orthopaedic surgery. Regular audit and feedback sessions may further improve consent documentation, alongside the targeting of high volume/low compliance surgeons.

Is After-Hours Orthopaedic Surgery Associated with Adverse Outcomes?

2009 ◽  
Vol 91 (9) ◽  
pp. 2067-2072 ◽  
Author(s):  
William M Ricci ◽  
Bethany Gallagher ◽  
Angel Brandt ◽  
John Schwappach ◽  
Michael Tucker ◽  
...  
Keyword(s):  
Orthopaedic Surgery ◽  
Adverse Outcomes ◽  
After Hours

Increased postoperative glucose variability is associated with adverse outcomes following orthopaedic surgery

2018 ◽  
Vol 100-B (8) ◽  
pp. 1125-1132 ◽  
Author(s):  
N. Shohat ◽  
C. Foltz ◽  
C. Restrepo ◽  
K. Goswami ◽  
T. Tan ◽  
...  
Keyword(s):  
Orthopaedic Surgery ◽  
Glucose Variability ◽  
Adverse Outcomes ◽  
Binary Outcomes ◽  
Diabetic Patients ◽  
Complication Rates ◽  
Glycaemic Variability ◽  
Glucose Levels ◽  
Blood Glucose Levels ◽  
The Mean

Aims The aim of this study was to examine the association between postoperative glycaemic variability and adverse outcomes following orthopaedic surgery. Patients and Methods This retrospective study analyzed data on 12 978 patients (1361 with two operations) who underwent orthopaedic surgery at a single institution between 2001 and 2017. Patients with a minimum of either two postoperative measurements of blood glucose levels per day, or more than three measurements overall, were included in the study. Glycaemic variability was assessed using a coefficient of variation (CV). The length of stay (LOS), in-hospital complications, and 90-day readmission and mortality rates were examined. Data were analyzed with linear and generalized linear mixed models for linear and binary outcomes, adjusting for various covariates. Results The cohort included 14 339 admissions, of which 3302 (23.0%) involved diabetic patients. Patients with CV values in the upper tertile were twice as likely to have an in-hospital complication compared with patients in the lowest tertile (19.4% versus 9.0%, p < 0.001), and almost five times more likely to die compared with those in the lowest tertile (2.8% versus 0.6%, p < 0.001). Results of the adjusted analyses indicated that the mean LOS was 1.28 days longer in the highest versus the lowest CV tertile (p < 0.001), and the odds of an in-hospital complication and 90-day mortality in the highest CV tertile were respectively 1.91 (p < 0.001) and 2.10 (p = 0.001) times larger than the odds of these events in the lowest CV tertile. These associations were significant even for non-diabetic patients. After adjusting for hypoglycaemia, the relationships remained significant, except that the CV tertile no longer predicted mortality in diabetics. Conclusion These results indicate that higher glycaemic variability is associated with longer LOS and in-hospital complications. Glycaemic variability also predicted death, although that primarily held for non-diabetic patients in the highest CV tertile following orthopaedic surgery. Prospective studies should examine whether ensuring low postoperative glycaemic variability may reduce complication rates and mortality. Cite this article: Bone Joint J 2018;100-B:1125–32.

scholarly journals Introducing an AKI predictive tool for patients undergoing orthopaedic surgery

2019 ◽  
Vol 8 (1) ◽  
pp. e000306 ◽  
Author(s):  
David Paul Baird ◽  
Fraser Rae ◽  
Christina Beecroft ◽  
Katherine Gallagher ◽  
Stephanie Sim ◽  
...  
Keyword(s):  
High Risk ◽  
Fluid Balance ◽  
Orthopaedic Surgery ◽  
Elective Surgery ◽  
Adverse Outcomes ◽  
Royal Infirmary ◽  
Predictive Tool ◽  
Electronic Tool ◽  
Increased Risk ◽  
Scoring Tool

Patients undergoing surgery are at increased risk of acute kidney injury (AKI). AKI is associated with adverse outcomes such as increased mortality and future risk of developing chronic kidney disease. We have developed a validated preoperative scoring tool to predict postoperative AKI in patients undergoing orthopaedic surgery using seven readily available parameters. The aim of this project was to establish the use of this scoring tool with a target compliance of 80% in patients undergoing orthopaedic surgery requiring an overnight stay at Perth Royal Infirmary, a district general hospital in NHS Tayside. We created an intervention bundle for patients at high risk of AKI, which we defined as greater than 10%. An electronic tool available on smartphones and desktop computers was developed that can be used to calculate the score. The interventions were incorporated into the electronic tool and posters outlining the intervention were placed in clinical areas. Patients undergoing elective procedures were scored in the preassessment clinic while emergency patients were scored by the admitting doctors. The score was introduced using four PDSA cycles. This confirmed that the scoring tool functioned well and was being used accurately. Compliance for patients undergoing elective surgery was reasonable at 19/24 (79%) in the third and fourth PDSA cycles but was poorer for emergency admissions with compliance of only 3/7 (43%). There was excellent compliance with the suggested medication changes and postoperative blood test monitoring as advised by our intervention bundle for those at high risk of AKI. Fluid balance monitoring was advised for all patients but the outcome was similar following our intervention at 27/41 (66%) compared with 23/37 (62%) in the baseline data collection. Compliance with fluid balance monitoring was higher in patients at high risk of AKI (9/12, 75%).

Research Consumerism 101: Evaluating External Evidence of Treatment Effectiveness

2008 ◽  
Vol 17 (2) ◽  
pp. 43-49
Author(s):  
James L. Coyle
Keyword(s):  
Treatment Effectiveness ◽  
Code Of Ethics ◽  
Oropharyngeal Dysphagia ◽  
Clinical Importance ◽  
Professional Services ◽  
Adverse Outcomes ◽  
Professional Judgment ◽  
Evidence Based ◽  
Intervention Selection ◽  
Published Research

Abstract The modern clinician is a research consumer. Rehabilitation of oropharyngeal impairments, and prevention of the adverse outcomes of dysphagia, requires the clinician to select interventions for which evidence of a reasonable likelihood of a successful, important outcome exists. The purpose of this paper is to provide strategies for evaluation of published research regarding treatment of oropharyngeal dysphagia. This article utilizes tutorial and examples to inform and educate practitioners in methods of appraising published research. It provides and encourages the use of methods of efficiently evaluating the validity and clinical importance of published research. Additionally, it discusses the importance of the ethical obligation we, as practitioners, have to use evidence-based treatment selection methods and measurement of patient performance during therapy. The reader is provided with tactics for evaluating treatment studies to establish a study's validity and, thereby, objectively select interventions. The importance of avoiding subjective or unsubstantiated claims and using objective methods of generating empirical clinical evidence is emphasized. The ability to evaluate the quality of research provides clinicians with objective intervention selection as an important, essential component of evidence-based clinical practice. ASHA Code of Ethics (2003): Principle I, Rule F: “Individuals shall fully inform the persons they serve of the nature and possible effects of services rendered and products dispensed…” (p. 2) Principle I, Rule G: “Individuals shall evaluate the effectiveness of services rendered and of products dispensed and shall provide services or dispense products only when benefit can reasonably be expected.” (p. 2) Principle IV, Rule G: “Individuals shall not provide professional services without exercising independent professional judgment, regardless of referral source or prescription.” (p. 4)

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