ABSTRACT
Purpose: Lifetime risk estimates show that the use of primary total shoulder replacement (TSR) surgery in Australia has increased in recent years, but future demand for surgery has not been estimated. This study aimed to forecast the number of primary TSR procedures likely to be performed in the year 2035, and associated costs to the Australian health system. Method(s): De-identified primary TSR data for 2009-2019 were obtained from the Australian Orthopaedic Association National Joint Replacement Registry. Australian population data (by age and sex) to the year 2021 and population projections to the year 2035 (by age and sex) were obtained from the Australian Bureau of Statistics. Data on average episode of care costs were sourced from the National Hospital Cost Data Collection and private health insurer websites. Procedure rates to the year 2035 were projected according to two scenarios: Scenario 1 assumed that the rate of TSR remained constant from 2019 onwards, with consideration of anticipated population growth and ageing;Scenario 2 assumed a continued increase in the rate of surgery as seen from 2009-2019 plus anticipated population growth and ageing. For Scenario 1, age- and sex-specific rates of TSR in 2019 were calculated and applied to population projections for the years 2020-2035. For Scenario 2, negative binomial regression models (which controlled for age, sex, and year) were used to estimate TSR procedures for the years 2020-2035. For both scenarios, healthcare costs for 2035 were estimated for the projected number of TSR procedures, with average procedure costs for public and private hospitals inflated to 2035 Australian dollars using the Total Health Price Index. Result(s): The use of TSR increased by 242% in Australia from 2009 to 2019 for adults over 40 years of age (from 1,983 to 6,789 procedures). In 2019, 60% of procedures (n=4,062) were performed for females and 73% (n=4,925) were performed for people aged 60-79 years. Fifty-three per cent of procedures in 2019 (n=3,608) were performed for osteoarthritis. Under Scenario 1, the incidence of TSR is predicted to rise from 6,789 procedures in 2019 to 9,676 procedures by 2035 (a 43% increase), at an estimated cost of $AUD 317.69 million. Under Scenario 2, TSR incidence is forecast to increase to 45,295 procedures by 2035 (a 567% increase) at an estimated cost of $AUD 1.49 billion. Under this scenario, 69% of the total forecast costs (equating to $AUD 1.02 billion) relate to the private hospital sector. Conclusion(s): The use of TSR in Australia has increased substantially over a decade, which likely relates to a range of factors including improvements in prosthesis design, improved clinical outcomes for patients, greater surgeon proficiency, and expanded clinical indications for surgery. Under a conservative forecasting scenario, a 43% in the number of procedures is estimated to occur by 2035. However, under an exponential growth scenario that considers growth in TSR rates plus population growth and ageing, Australia would be facing a more than five-fold increase in TSR procedures by 2035. This would have profound implications for the healthcare budget and surgical workforce requirements. Future research is needed to model the impacts of COVID-19 on TSR provision and catch up of unmet need due to elective surgery restrictions and cancellations.Copyright © 2023
ABSTRACT
Designing a surface that can disinfect itself can reduce labor-intensive cleanings and harmful waste, and mitigate spread of surface borne diseases. Additionally, since COVID-19 is an airborne pathogen, surface modification of masks and filters could assist with infection control. Styrene-maleic acid (SMA) copolymers and their derivatives were shown to have lipid-bilayer disrupting properties, making them candidates as anti-viral materials. A series of network polymers with styrene-maleic acid-based polymers and control over polymer chain-length and composition were synthesized. All the polymers formed mechanically robust structures, with tunable Young's moduli on the order of MPa, and tunable swelling capability in water. The SMA-based bulk materials, containing a zwitterionic polar unit, showed excellent lipid disrupting properties, being up to 2 times more efficient than a 10% Triton solution. The highest performance was observed for materials with lower crosslink densities or shorter chain-lengths, with lipid disruption capability correlating with swelling ratio. Additionally, the material can capture the spike protein of SARS-CoV-2, with up to 90% efficiency. Both the lipid disrupting and spike protein capture ability could be repeated for multiple cycles. Finally, the materials are shown to modify various porous and non-porous substrates including surgical and KN95 masks. Functional network modified masks had up to 6 times higher bilayer disruption ability than the unmodified masks without inhibiting airflow. © 2022 The Royal Society of Chemistry.
ABSTRACT
Introduction In March 2020, it was recognised the COVID-19 pandemic posed a major risk to the National Health Service (NHS) in terms of intensive care units (ICU) capacity. Several studies have shown the benefits of tracheostomy in reducing length of stay (LoS) and duration of mechanical ventilation. As a result, it was recognised the use of tracheostomy would facilitate increased ICU capacity during the COVID-19 surge. The primary aim of this investigation is to report on clinical outcomes in adult patients diagnosed with COVID-19 requiring tracheostomy over the time period March 2020 to July 2020, at three University College London Partner organisations. Method A prospective multi-centre observational study was undertaken from 17th March 2020 to 3rd July 2020 on all tracheostomised COVID-19 positive patients (aged > 16 yrs). Patients with long term tracheostomies were excluded. Data were collected by multiprofessional ventilation weaning teams. Data collected included;initial diagnosis, indication for tracheostomy, tube insertion procedure, type of tube, tube changes, complications, decannulation, time to first cuff deflation/speaking valve and patient outcomes. Results 139 patients were included. Mean(SD) age 58.3(11.01) with a higher proportion of male:female (M:F 108:31). The primary indication for tracheostomy was prolonged ventilation (n=111, 79%). The secondary indication was low arousal (n=16, 11%). A higher prevalence of surgery tracheostomies was found (n=89, 63%). The mean(SD) time from intubation to tracheostomy insertion was 21(9)days. The mean(SD) days to first cuff deflation was 34(14). The mean(SD) ICU LoS was 39(16)days and total hospital LoS was 51 (22) days. The mean(SD) time to decannulation from tracheostomy insertion was 25(16)days and time to decannulation from intubation was 46(18)days. A mortality rate of 10%(n=14) was observed. There was no correlation between ICU LoS and age (r=-0.022) (p=0.804). There was a weak significant correlation between ICU LoS and timing of tracheostomy (r=0.393, p£0.0001). Conclusion The low mortality rate suggests appropriate patient selection for tracheostomy, but also makes analysis of potential influences on mortality difficult to ascertain. Our data suggests timing of tracheostomy could impact on ICU LoS. This data could inform practice surrounding tracheostomy insertion during future global pandemics.
ABSTRACT
P62 Table 1The impact of timing of tracheostomy on Intensive Care Unit Length of Stay Mean(SD) ICU LoS (days) P value Early tracheostomy (<10 days) n=10 31(14) p=0.005 Late tracheostomy (≥10 days <27 days) n=82 38(15) Delayed tracheostomy (≥27 days) n=32 46(17) ConclusionThe low mortality rate suggests appropriate patient selection for tracheostomy, but also makes analysis of potential influences on mortality difficult to ascertain. Our data suggests timing of tracheostomy could impact on ICU LoS. This data could inform practice surrounding tracheostomy insertion during future global pandemics.