ABSTRACT
INTRODUCTION: COVID-19 has presented the surgical community with a multitude of challenges. Patients requiring surgical intervention who are positive for COVID-19 are not only more likely to develop complications post-operatively, but also pose an increased infection risk to the surgical team involved in their care. The infection control concerns raised at the peak of the pandemic persist in the post-pandemic era as patients continue to test positive for COVID-19 and the risk of a 'second wave' looms. METHODS: We present a case series (compliant with SCARE [4] and PROCESS [5] criteria) to demonstrate the effective use of an AR technology platform during the intraoperative treatment of two complex COVID positive patients diagnosed with Fournier's gangrene.Retrospective review of prospectively collected data of all patients that required surgery involving multiple specialties during the COVID-19 pandemic at Jaber AlAhmad hospital in Kuwait between March 2020 to October 2020. PRESENTATION OF CASE: We present two cases to highlight the use of an augmented reality (AR) platform during the treatment of COVID-19 positive patients with Fournier's gangrene in order to safeguard surgical teams whilst simultaneously enabling these complex cases to benefit from multi-specialty input intraoperatively. OUTCOME: Augmented reality is a feasible option to minimize surgeons' exposure during surgery without compromising the patients safety. DISCUSSION: This case series demonstrates how AR solutions can be employed to bolster infection control measures and may be useful in the treatment of surgical patients who test positive for COVID-19. CONCLUSION: AR solutions could be considered as an infection control strategy to safeguard surgical teams operating on COVID-19 positive patients.
ABSTRACT
Introduction Up to 19% of patients who undergo surgery for an acute hip fracture are readmitted to the hospital within three months of the index operation. We aimed to identify risk factors for unplanned clinic attendance, readmission, and mortality within the first 12 months postoperatively and subsequently determine if there is a role for routine follow-up. Method Patients greater than 65 years old who underwent hip hemiarthroplasty using an uncemented Thompson implant for treatment of a traumatic non-pathological hip fracture were identified from a prospectively maintained database at a single institution between August 2007 and February 2011. Patient demographics, comorbidities, place of residence, mobility status, unplanned attendance to an orthopaedic clinic with symptoms relating to the respective limb, readmission, and mortality were recorded. Regression analysis was performed using the IBM Statistical Package for Social Sciences (SPSS), version 24 (IBM SPSS Statistics, Armonk, NY) with P < 0.05 considered significant. Results Five hundred and fifty-four consecutive patients were identified. Unplanned clinic attendance was correlated to age (p = 0.000, B = -0.0159, 95% confidence interval (CI): -0.200 to -0.65), with patients between the ages of 65 - 70 years most likely to require unplanned clinic review postoperatively. The American Society of Anesthesiologists (ASA) grade (p = 0.019, 95% CI: 0.014 to 0.163) and frequency of unplanned outpatient attendance (p = 0.000, 95% CI: 0.120 to 0.284) were significantly associated with increased readmission within 12 months of the index procedure with patients who were regarded as ASA > 2 most likely to require readmission within the first postoperative year. Conclusion To our knowledge, this is the first piece of research that identifies causative factors for unplanned clinic attendance and acute readmission during the first postoperative year in acute hip fracture patients treated by hemiarthroplasty. Routine scheduled follow-up of patients based on risk stratification may be effective in reducing the financial burden of unplanned clinic attendance.
