scholarly journals Cytokine Changes in Cerebrospinal Fluid and Plasma Post-Emergency Orthopaedic Surgery

2021 ◽  
Author(s):  
Michael Fertleman ◽  
Christopher Pereira ◽  
Melanie Dani ◽  
Benjamin H. L. Harris ◽  
Matteo Di Giovannantonio ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Orthopaedic Surgery ◽  
Fractured Neck Of Femur ◽  
Neck Of Femur ◽  
Plasma Cytokine ◽  
Neuroinflammatory Response ◽  
Paired Samples ◽  
Cytokine Levels ◽  
Before And After ◽  
Spinal Catheter

Abstract Background: The process of neuroinflammation after surgery and how it may contribute to post-operative neurocognitive disorders (PND) is not well understood. Studying the association between central and peripheral cytokines and neuroinflammation is a prelude to the development of treatments for PND. Here, we investigate the hypotheses that there is a greater cytokine response in cerebrospinal fluid (CSF) than plasma after orthopaedic surgery, and that plasma cytokine levels are directly related to CSF cytokine levels, enabling plasma cytokine levels to be used as markers of neuroinflammation. Methods: Patients admitted with a fractured neck of femur were invited to participate in this study. Participants had a spinal catheter inserted just prior to induction of anaesthesia. Samples of blood and CSF were taken before, immediately after, and on the first day following emergency surgery. The catheter was then removed. Samples were analysed for the presence of ten cytokines by immunoassay. Results: A spinal catheter was successfully inserted in 11 participants during the 18-month study period. Five plasma cytokines (IL-4, IL-6, IL-10, IL-12p70 and IL-13) rose significantly following surgery, whereas all ten CSF cytokines rose significantly (IL-1β, IL-2, IL-4, IL-6, IL-8, IL-10, IL-12p70, IL-13, IFN-γ and TNF-α) (adjusted-p <0.05). Central (CSF) cytokine levels were consistently higher than their peripheral (plasma) counterparts after surgery, with some patients having a particularly marked neuroinflammatory response. The greatest increases occurred in IL-8 in CSF and IL-6 in plasma. There were significant, strong positive correlations between several of the measured cytokines in the CSF after surgery, but far fewer in plasma. There was no significant correlation between cytokine levels in the plasma and CSF at each of the three time points.Conclusions: To our knowledge, this is the first study to analyse paired samples of plasma and CSF for cytokine levels before and after emergency orthopaedic surgery. This study demonstrates that following surgery for a fractured neck of femur, there is a far greater rise in cytokines in the CSF compared to plasma. The lack of correlation between peripheral and central cytokines suggests measurement of peripheral cytokines are not necessarily related to which patients may have a large neuroinflammatory response.

scholarly journals 30-day mortality following trauma and orthopaedic surgery during the peak of the COVID-19 pandemic

2020 ◽  
Vol 1 (7) ◽  
pp. 392-397 ◽  
Author(s):  
Paul N. Karayiannis ◽  
Veronica Roberts ◽  
Roslyn Cassidy ◽  
Alistair I. W. Mayne ◽  
Daryl McAuley ◽  
...  
Keyword(s):  
Orthopaedic Surgery ◽  
Postoperative Mortality ◽  
Fractured Neck Of Femur ◽  
Neck Of Femur ◽  
Specific Data ◽  
Risk Of Death ◽  
Deceleration Phase ◽  
Time Period ◽  
American Society ◽  
American Society Of Anesthesiologists

Aims Now that we are in the deceleration phase of the COVID-19 pandemic, the focus has shifted to how to safely reinstate elective operating. Regional and speciality specific data is important to guide this decision-making process. This study aimed to review 30-day mortality for all patients undergoing orthopaedic surgery during the peak of the pandemic within our region. Methods This multicentre study reviewed data on all patients undergoing trauma and orthopaedic surgery in a region from 18 March 2020 to 27 April 2020. Information was collated from regional databases. Patients were COVID-19-positive if they had positive laboratory testing and/or imaging consistent with the infection. 30-day mortality was assessed for all patients. Secondly, 30-day mortality in fracture neck of femur patients was compared to the same time period in 2019. Results Overall, 496 operations were carried out in 484 patients. The overall 30-day mortality was 1.9%. Seven out of nine deceased patients underwent surgery for a fractured neck of femur. In all, 27 patients contracted COVID-19 in the peri-operative period; of these, four patients died within 30 days (14.8%). In addition, 21 of the 27 patients in this group had a fractured neck of femur, 22 were over the age of 70 years (81.5%). Patients with American Society of Anesthesiologists (ASA) grade > 3 and/or age > 75 years were at significantly higher risk of death if they contracted COVID-19 within the study period. Conclusion Overall 30-day postoperative mortality in trauma and orthopaedic surgery patients remains low at 1.9%. There was no 30-day mortality in patients ASA 1 or 2. Patients with significant comorbidities, increasing age, and ASA 3 or above remain at the highest risk. For patients with COVID-19 infection, postoperative 30-day mortality was 14.8%. The reintroduction of elective services should consider individual patient risk profile (including for ASA grade). Effective postoperative strategies should also be employed to try and reduce postoperative exposure to the virus. Cite this article: Bone Joint Open 2020;1-7:392–397.

Anaesthesia for orthopaedic and trauma surgery

2017 ◽  
Author(s):  
Alex Sell ◽  
Paul Bhalla ◽  
Sanjay Bajaj
Keyword(s):  
Orthopaedic Surgery ◽  
Enhanced Recovery ◽  
Spinal Injury ◽  
Trauma Surgery ◽  
Bone Tumour ◽  
Initial Assessment ◽  
Fractured Neck Of Femur ◽  
Neck Of Femur ◽  
Embolism Syndrome ◽  
The Impact

This chapter is divided into three main sections. The first section concerns the patient population that presents for orthopaedic surgery, specifically examining chronic diseases of the musculoskeletal system and the medications commonly used for their management, and the impact this has when these patients present for surgery. Included in this section are the surgical considerations and the anaesthetic implications of orthopaedic surgery, ranging from patient positioning to bone cement implant syndrome. The last part of this first section looks at specific orthopaedic operations, starting with the most commonly performed, hip and knee arthroplasties, and moving onto the specialist areas of spinal deformity, paediatric, and bone tumour surgery that are not usually found outside of specialist centres. The middle section gives a brief overview on analgesia concentrating on pharmacological methods as, although orthopaedic surgery lends itself well to regional anaesthesia, this is covered elsewhere in its own dedicated chapters. No section on analgesia would be complete without mentioning enhanced recovery: the coordinated, multidisciplinary approach that improves the patient experience, increases early mobilization, and reduces length of stay, which should be the standard obtained for every patient. The final section covers the anaesthetic management of in-hospital trauma, giving an overview on initial assessment, timing of surgery, and management of haemorrhage and coagulopathy. This section finishes by covering the orthopaedic-specific topics of compartment syndrome, fat embolism syndrome, and the management of fractured neck of femur and spinal injury.

Anaesthesia for orthopaedic surgery

2014 ◽  
Author(s):  
Jeremy Prout ◽  
Tanya Jones ◽  
Daniel Martin
Keyword(s):  
Regional Anaesthesia ◽  
Orthopaedic Surgery ◽  
Perioperative Management ◽  
Revision Arthroplasty ◽  
Joint Arthroplasty ◽  
Physiological Changes ◽  
Medical Comorbidity ◽  
Fractured Neck Of Femur ◽  
Neck Of Femur ◽  
Spinal Cord Function

The risks, benefits, and evidence for use of regional anaesthesia techniques are discussed generally and for specific procedures such as joint arthroplasty. Other perioperative considerations for primary and revision arthroplasty are described. The particular challenges of the patients presenting with fractured neck of femur, physiological changes of older age and goals for perioperative management are highlighted. Surgical procedures for scoliosis are performed in specialist centres and are discussed. Associated medical comorbidity, anaesthetic considerations and neurological monitoring for spinal cord function are described.

scholarly journals Standardised Warfarin Reversal Expedites Time to Theatre for Fractured Neck of Femur Surgery and Improves Mortality Rates: A Matched Cohort Study

2018 ◽  
Vol 2018 ◽  
pp. 1-8 ◽  
Author(s):  
Thomas S. Moores ◽  
Benjamin D. Chatterton ◽  
Matthew J. Walker ◽  
Phillip J. Roberts
Keyword(s):  
Cohort Study ◽  
Hip Fracture ◽  
Length Of Stay ◽  
Nearest Neighbour ◽  
Fractured Neck Of Femur ◽  
Neck Of Femur ◽  
The United Kingdom ◽  
Before And After ◽  
Warfarin Reversal ◽  
Guideline Group

Background. This study aims to evaluate outcomes for warfarinised hip fracture patients and compare them with a matched nonwarfarinised group, before and after the introduction of national hip fracture guidelines in the United Kingdom. Methods. A retrospective cohort study of 1743 hip fracture patients was undertaken. All patients admitted taking warfarin were identified. These patients were then matched to nonwarfarinised patients using nearest neighbour propensity score matching, accounting for age, sex, hip fracture type, and Nottingham Hip Fracture Score. A pre-guideline group (no standardised warfarin reversal regimen) and a post-guideline group (standardised regimen) were identified. Outcomes assessed included time to INR less than 1.7, time to theatre, length of stay, and 30-day and 1-year mortality. Results. Forty-six warfarinised hip fracture patients were admitted in the pre-guideline group (mean age 80.5, F:M 3:1) and 48 in the post-guideline group (mean age 81.2 years, F:M 3:1). Post-guideline patients were reversed to a safe operative INR level within 18 hours of admission, decreasing the time to first dose vitamin K (p<0.001). 70% of warfarinised patients were operated upon within 36 hours, compared to 19.6% with no regimen (p<0.05). After anticoagulation reversal protocol, thirty-day mortality decreased from 15.2% to 8.3% and 1-year mortality from 43.5% to 33% for warfarinised patients, which is comparable to nonwarfarinised matched patients. There was no significant change in the length of stay pre- and post-guideline for both groups of patients. Conclusions. Proactive anticoagulant management and expedient surgery reduces morbidity and mortality when managing this surgically challenging subset of hip fracture patients.

scholarly journals 30-day mortality following trauma and orthopaedic surgery during the peak of the COVID-19 pandemic

2020 ◽  
Vol 1 (7) ◽  
pp. 392-397
Author(s):  
Paul N. Karayiannis ◽  
Veronica Roberts ◽  
Roslyn Cassidy ◽  
Alistair I. W. Mayne ◽  
Daryl McAuley ◽  
...  
Keyword(s):  
Orthopaedic Surgery ◽  
Postoperative Mortality ◽  
Fractured Neck Of Femur ◽  
Neck Of Femur ◽  
Specific Data ◽  
Risk Of Death ◽  
Deceleration Phase ◽  
Time Period ◽  
American Society ◽  
American Society Of Anesthesiologists

Aims Now that we are in the deceleration phase of the COVID-19 pandemic, the focus has shifted to how to safely reinstate elective operating. Regional and speciality specific data is important to guide this decision-making process. This study aimed to review 30-day mortality for all patients undergoing orthopaedic surgery during the peak of the pandemic within our region. Methods This multicentre study reviewed data on all patients undergoing trauma and orthopaedic surgery in a region from 18 March 2020 to 27 April 2020. Information was collated from regional databases. Patients were COVID-19-positive if they had positive laboratory testing and/or imaging consistent with the infection. 30-day mortality was assessed for all patients. Secondly, 30-day mortality in fracture neck of femur patients was compared to the same time period in 2019. Results Overall, 496 operations were carried out in 484 patients. The overall 30-day mortality was 1.9%. Seven out of nine deceased patients underwent surgery for a fractured neck of femur. In all, 27 patients contracted COVID-19 in the peri-operative period; of these, four patients died within 30 days (14.8%). In addition, 21 of the 27 patients in this group had a fractured neck of femur, 22 were over the age of 70 years (81.5%). Patients with American Society of Anesthesiologists (ASA) grade > 3 and/or age > 75 years were at significantly higher risk of death if they contracted COVID-19 within the study period. Conclusion Overall 30-day postoperative mortality in trauma and orthopaedic surgery patients remains low at 1.9%. There was no 30-day mortality in patients ASA 1 or 2. Patients with significant comorbidities, increasing age, and ASA 3 or above remain at the highest risk. For patients with COVID-19 infection, postoperative 30-day mortality was 14.8%. The reintroduction of elective services should consider individual patient risk profile (including for ASA grade). Effective postoperative strategies should also be employed to try and reduce postoperative exposure to the virus. Cite this article: Bone Joint Open 2020;1-7:392–397.

scholarly journals Clopidogrel: is a surgical delay necessary in fractured neck of femur?

2011 ◽  
Vol 93 (4) ◽  
pp. 310-313 ◽  
Author(s):  
Iheanyi C Nwachuku ◽  
Morgan Jones ◽  
Timothy M Clough
Keyword(s):  
Femur Fracture ◽  
Early Surgery ◽  
Proximal Femur Fracture ◽  
Fractured Neck Of Femur ◽  
Neck Of Femur ◽  
Surgery Group ◽  
Before And After ◽  
The Mean ◽  
Late Group ◽  
Postoperative Haemoglobin

INTRODUCTION This paper assesses the outcomes of patients after surgery for a proximal femur fracture while on clopidogrel. It describes a single-centre retrospective observational study over a two-year period. PATIENTS AND METHODS A total of 31 surgical patients were included in this study. Of these, 28 were on clopidogrel and 3 on dipyridamole. Patients were split into subgroups based on when surgery took place and the type of hip fracture. The ‘early surgery’ (<48 hours from admission to theatre) group contained 16 patients (51.6%) and the ‘late surgery’ (>48 hours) group composed 15 patients (48.4%). Type of surgery performed and pre-and postoperative haemoglobin (Hb) levels were recorded. Furthermore, the number of units of blood transfused per patient as well as complications before and after surgery were noted. RESULTS A significantly larger mean Hb drop occurred in the early surgery group (3.2g/dl) compared with the late surgery group (2.3g/dl) (p=0.027). The mean length of inpatient stay was 21 days in the early and 23 days in the late group (p=0.456). A significantly larger Hb mean drop occurred in patients with extracapsular hip fractures (3.4g/dl; n=16) compared with patients with intracapsular fractures (2.3g/dl; n=15) (p=0.020). The extracapsular patients had longer stays in hospital: 24.5 days versus 19.8 days in the intracapsular group (p=0.521). There was no statistical difference in the 30-day mortality between the early surgery (3/16 deaths) and late surgery (2/15 deaths) groups (p=0.481). CONCLUSIONS Patients with extracapsular fractures, treated with early surgery, appear to be most at risk of complications after surgery.

Trial of Aspirin and RA 233 in Prevention of Post-operative Deep Vein Thrombosis

1973 ◽  
Vol 30 (01) ◽  
pp. 018-024 ◽  
Author(s):  
Edward H. Wood ◽  
Colin R.M. Prentice ◽  
D. Angus McGrouther ◽  
John Sinclair ◽  
George P. McNicol
Keyword(s):  
Deep Vein Thrombosis ◽  
Controlled Trial ◽  
Oral Anticoagulants ◽  
Antithrombotic Agent ◽  
Fractured Neck Of Femur ◽  
Neck Of Femur ◽  
Vein Thrombosis ◽  
Effective Prophylaxis ◽  
Deep Vein ◽  
Calf Vein

SummaryAlthough the oral anticoagulants provide effective prophylaxis against postoperative deep vein thrombosis following fracture of neck of femur there is a need for an antithrombotic agent which needs less laboratory control and does not cause haemorrhagic complications. It has been suggested that drugs causing inhibition of platelet function may fulfil these requirements. A controlled trial was carried out in which aspirin, RA 233, or a combination of these drugs was compared with a placebo in the prevention of post-operative deep vein thrombosis. In thirty patients undergoing surgery for fractured neck of femur the incidence of post-operative calf vein thrombosis, as detected by 125I-fibrinogen scanning, was not significantly different between the untreated and treated groups.

Melatih Kepemimpinan Perangkat Desa Kebonharjo Kulonprogo: Membangun Sikap Anti Korupsi

2018 ◽  
Vol 1 ◽  
pp. 107
Author(s):  
Adi Heryadi ◽  
Evianawati Evianawati
Keyword(s):  
Transformational Leadership ◽  
Data Collection ◽  
Paired Samples ◽  
Significant Difference ◽  
Before And After ◽  
Post Test ◽  
Sample Test ◽  
Corruption Perception ◽  
Measuring Tool

This study aims to prove whether transformational leadership training is effective for building anti-corruption attitudes of villages in Kebonharjo village, subdistrict Samigaluh Kulonprogo. This research is an experimental research with one group pre and posttest design.Subject design is 17 people from village of 21 candidates registered. Measuring tool used in this research is the scale of anti-corruption perception made by the researcher referring to the 9 anti-corruption values with the value of reliability coefficient of 0.871. The module used as an intervention made by the researcher refers to the transformational leadership dimension (Bass, 1990). The data collected is analyzed by statistical analysis of different test Paired Sample Test. Initial data collection results obtained sign value of 0.770 which means> 0.05 or no significant difference between anti-corruption perception score between before and after training. After a period of less than 1 (one) month then conducted again the measurement of follow-up of the study subjects in the measurement again using the scale of anti-corruption perception. The results of the second data collection were analysed with Paired Samples Test and obtained the value of 0.623 sign meaning p> 0.05 or no significant difference between post test data with follow-up data so that the hypothesis of this study was rejected.

102 Peer Teaching in Hip Fracture: Responding to the Medical Needs of Surgical Patients and Educational Needs of Junior Doctors

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
N Jones ◽  
J Francis ◽  
R Parikh ◽  
M Shaath
Keyword(s):  
Metastatic Cancer ◽  
Vascular Complications ◽  
Educational Programme ◽  
Junior Doctors ◽  
Fractured Neck Of Femur ◽  
Neck Of Femur ◽  
Teaching Programme ◽  
Medical Needs ◽  
Strongly Agree ◽  
Case Based

Abstract Introduction Fractured Neck of Femur (FNOF) patients are complex. A mortality project identified topics for a peer-led teaching programme. Method Eight bite-sized case-based sessions were devised, to provide a framework to approach the following topics: Anaemia, delirium/dementia, ECG abnormalities, metastatic cancer, osteoporosis, renal disease, respiratory disease, and vascular complications. Attendees were asked to complete pre- and post- teaching programme questionnaires using a Likert Scale to indicate agreement with statements relating to the topic areas chosen (1=strongly disagree and 5=strongly agree). Result Pre-programme questionnaire: respondents were neutral (average 3.04) when asked whether topic areas were currently “well managed”. Attendees lacked confidence, indicating preparedness as neutral (average 3.35). Trainees agreed that they would benefit from teaching (average 4.56). Post-programme questionnaire: increased confidence was reported when considering preparedness (average 4.3). Attendees felt the teaching programme was “accessible” and the “topics well-chosen”. 100% of attendees regarded the teaching as ‘excellent’ or ‘very-good’. Conclusions Matching patient needs to an educational programme is important. The “bite-sized” nature of the programme paired with case-based learning increased confidence. A peer-led teaching programme is a positive response to themes emerging from morbidity and mortality reviews.

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