The Impact of the COVID-19 Pandemic on Orthopaedic Trauma Surgery in a District General Hospital in the United Kingdom.

Introduction The 2020 COVID-19 pandemic led to a national lockdown and a major reorganization of healthcare services in the United Kingdom. The center where the study was done was one of the worst affected hospitals in the United Kingdom at the outset of the pandemic. Our study evaluates the impact of the pandemic and national lockdown on the outcomes for patients undergoing orthopedic trauma surgery. Methods We prospectively identified all patients undergoing orthopedic trauma surgery in the unit from 1st March 2020 to 31st May 2020. We recorded demographics, diagnoses, COVID-19 infection status, length of stay, and mortality. This was compared with a comparative group in the same period in 2018 and 2019. Results There was a significant reduction in the number of orthopedic trauma surgery cases (318) performed in 2020 compared to 2019 (423 cases, p<0.001) and 2018 (444 cases, p<0.001). The mean time from injury to presentation was 3.6 days, with 40 patients (12.6%) presenting more than one week after injury. The 30-day mortality was 8.2%, and the six-month mortality was 15.1%, with both significantly higher than in 2018 (p<0.001) and 2019 (p<0.001). COVID-19 testing was positive in 39% of patients, with 30-day mortality in this group at 37%, rising to a 53% six-month mortality. No patients under the age of 50 years old died. The majority of admissions (51%) were due to falls at home. The second most common mechanism was Do-It-Yourself (DIY) injuries. Road traffic accidents accounted for 2%. Conclusion There were significantly fewer cases of orthopedic trauma surgery during the first wave of the COVID-19 pandemic compared to the same period in previous years. The type of trauma also showed low numbers of high-energy and sporting injuries as a result of the national lockdown. Patients undergoing orthopedic trauma surgery who tested positive for COVID-19 had significantly higher 30-day mortality than those without COVID-19, and this increased mortality persisted to six months post-operatively. However, patients under 50 years old appear to be at low risk of death.

Intraoperative Fluoroscopic Radiation Exposure During Hip Fracture Fixation: A Study Combining Surgical Experience and Fracture Complexity.

Aim Hip fracture fixation surgeries are one of the most common surgeries that every trauma unit does regularly. Surgical training and expertise to fix these fractures properly are quite crucial for every orthopaedic surgeon. Therefore, orthopaedic training programmes all over the world consider significant focus on this and teach trainee surgeons expectantly to manage these fractures independently. Surgical fixation of hip fractures often requires fluoroscopy assistance in the operating theatre with associated hazards from ionising radiation. Moreover, hip fractures can be sometimes quite complex and may require relatively more fluoroscopy usage even with the higher grade of the operating surgeons. Therefore, training need for hip fracture fixation surgery is imperative and there is also a need for intraoperative radiation safety. This study has tried to find a balance between intraoperative fluoroscopic radiation exposure, surgical training requirement, and hip fracture complexity. Methodology This single centre study has collected retrospective peri-operative data over a period of two years including hip fractures that required fluoroscopy-guided surgical fixation. Femoral head fractures, subtrochanteric fractures, diaphyseal fractures, and trochanteric fractures with associated pelvic fractures were excluded from the study. We collected data on demographic parameters, fracture complexity and grading (Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association [AO/OTA] Classification), intraoperative ionising radiation exposure (centi-Gray/cm2), and grade of the operating surgeon in order to find any relation between these factors. Results Total 268 patients were included in the study with a mean age of 81.8 years (SD 9.3) comprising of 83 (31%) male patients and 185 (69%) female patients. The study population was further stratified into three groups depending upon the operating grade of the surgeon: 'Junior Trainee' (five years of experience; 148 cases [55%]); and 'Consultant' (fully trained to practice independently; 43 cases [16%]). There was no statistically significant difference among these three sub-groups with regards to the age (p = 0.79), gender (p = 0.73), body mass index (p = 0.46), and fracture pattern (p = 0.96) of the patients. However, consultants tend to operate more on the higher American Society of Anesthesiologists (ASA) grade patients (p = 0.049) with more comorbidities. There was statistically significant higher fluoroscopic radiation exposure while junior trainee surgeons (p = 0.005) were operating and during the higher complex grade of hip fracture (p = <0.001) fixation. Conclusion In conclusion, the quantity of intra-operative radiation dose utilised in the surgical fixation of hip fractures is significantly associated with the grade and level of training of the operating surgeon and fracture complexity type. The results of this study emphasise and support the importance of comprehensive, supervised, and structured orthopaedic training for in-theatre radiation safety. It is recommended to have a safe balance between teaching, learning, and prevention of ionising radiation hazards in order to optimally achieve trainee's professional development with successful patient outcomes.

The impact of a spinal best practice tariff on compliance with the British Spine Registry.

AIMS: The British Spine Registry (BSR) was introduced in May 2012 to be used as a web-based database for spinal surgeries carried out across the UK. Use of this database has been encouraged but not compulsory, which has led to a variable level of engagement in the UK. In 2019 NHS England and NHS Improvement introduced a new Best Practice Tariff (BPT) to encourage input of spinal surgical data on the BSR. The aim of our study was to assess the impact of the spinal BPT on compliance with the recording of surgical data on the BSR. METHODS: A retrospective review of data was performed at a tertiary spinal centre between 2018 to 2020. Data were collated from electronic patient records, theatre operating lists, and trust-specific BSR data. Information from the BSR included operative procedures (mandatory), patient consent, email addresses, and demographic details. We also identified Healthcare Resource Groups (HRGs) which qualified for BPT. RESULTS: A total of 3,587 patients were included in our study. Of these, 1,684 patients were eligible for BPT. Between 2018 and 2019 269/974 (28%) records were complete on the BSR for those that would be eligible for BPT. Following introduction of BPT in 2019, 671/710 (95%) records were complete having filled in the mandatory data (p < 0.001). Patient consent to data collection also improved from 62% to 93%. Email details were present in 43% of patients compared with 68% following BPT introduction. CONCLUSION: Our study found that following the introduction of a BPT, there was a statistically significant improvement in BSR record completion compliance in our unit. The BPT offers a financial incentive which can help generate further income for trusts. National data input into the BSR is important to assess patient outcome following spinal surgery. The BSR can also aid future research in spinal surgery. Cite this article: Bone Jt Open 2021;2-3:198-201.