ABSTRACT
AIM: This study aims to estimate the risk of acquiring medical complication or death from COVID-19 infection in patients who were admitted for orthopaedic trauma surgery during the peak and plateau of pandemic. Unlike other recently published studies, where patient-cohort included a more morbid group and cancer surgeries, we report on a group of patients who had limb surgery and were more akin to elective orthopaedic surgery. METHODS: The study included 214 patients who underwent orthopaedic trauma surgeries in the hospital between 12th March and 12th May-2020 when the pandemic was on the rise in the United Kingdom. Data was collected on demographic profile including comorbidities, ASA grade, COVID-19 testing, type of procedures and any readmissions, complications or mortality due to COVID-19. RESULTS: There were 7.9% readmissions and 52.9% of it was for respiratory complications. Only one patient had positive COVID-19 test during readmission. 30-day mortality for trauma surgeries was 0% if hip fractures were excluded and 2.8% in all patients. All the mortalities were for proximal femur fracture surgeries and between ASA Grade 3 and 4 or in patients above the age of 70 years. CONCLUSION: This study suggests that presence of COVID-19 virus in the community and hospital did not adversely affect the outcome of orthopaedic trauma surgeries or lead to excess mortality or readmissions in patients undergoing limb trauma surgery. The findings also support resumption of elective orthopaedic surgeries with appropriate risk stratification, patient optimization and with adequate infrastructural support amidst the recovery phase of the pandemic.
ABSTRACT
PURPOSE: To investigate if previous intravitreal anti vascular endothelial growth factor (VEGF) injections are a predictor for posterior capsule rupture (PCR) during phacoemulsification cataract surgery. SETTING: National Health Service: Whipps Cross University Hospital Eye Treatment Centre. District General, London, United Kingdom DESIGN:: Single centre, retrospective, electronic medical record (EMR) database study with univariate analysis. METHODS: EMR (Medisoft) was used to extract data for eyes undergoing phacoemulsification surgery between 01.08.16 to 01.01.18. Patient demographics, indication for intravitreal therapy, treatment type, number of previous intravitreal injections (IVI), diabetic status, surgeon grade and operative complications were included as variables for analysis. RESULTS: Data was available for 4047 cataract operations. Of these, 108 had undergone previous anti-VEGF IVI treatment. Three eyes were noted to have pre-operative PC trauma and were excluded from the final analysis. The logistic regression analysis after exclusion of the eyes with pre-existing damage to the PC confirmed that prior anti-VEGF IVI treatment was associated with an increased risk of PCR when compared to the non IVI group (9.26% vs 1.88%, p<0.0001). There is a dose dependent relationship between the number of anti-VEGF injections and the likelihood of PCR. CONCLUSIONS: Previous intravitreal anti-VEGF injections are significantly correlated with an increased risk of surgical PCR despite the absence of visible structural damage to the PC pre-operatively.
ABSTRACT
PURPOSE: To investigate whether previous intravitreal antivascular endothelial growth factor (VEGF) injections are a predictor for posterior capsular rupture (PCR) during phacoemulsification cataract surgery. SETTING: Whipps Cross University Hospital Eye Treatment Centre, London, United Kingdom. DESIGN: Single-center, retrospective, electronic medical record (EMR) database study with univariate analysis. METHODS: Data were extracted from an EMR system on eyes undergoing phacoemulsification surgery between August 1, 2016, and January 1, 2018. Patient demographics, indication for intravitreal therapy, treatment type, the number of previous intravitreal injections (IVIs), diabetic status, surgeon grade, and operative complications were included as variables for analysis. RESULTS: Data were available for 4047 cataract operations. Of these, 108 (2.7%) had undergone previous anti-VEGF IVI treatment. Three eyes were noted to have preoperative PC trauma and were excluded from the final analysis. The logistic regression analysis after exclusion of the eyes with pre-existing damage to the PC confirmed that previous anti-VEGF IVI treatment was associated with an increased risk of PCR when compared with the non-IVI group (6.67% vs 1.88%, P < .0001). There is a dose-dependent relationship between the number of anti-VEGF injections and the likelihood of PCR. CONCLUSIONS: Previous intravitreal anti-VEGF injections are significantly correlated with an increased risk of surgical PCR, despite the absence of visible structural damage to the posterior capsule preoperatively.
