ABSTRACT
INTRODUCTION: The weekend effect has been defined as a real or perceived decline in patient care provided on weekends and that provided on weekdays. The primary aim of this study was to investigate the association between day of surgery and length of stay for patients receiving elective lower limb joint arthroplasty in a large NHS teaching hospital. MATERIALS AND METHODS: Data were obtained from a prospectively collected database of consecutive patients undergoing elective primary total knee and hip arthroplasty. Patient and clinical variables were collected alongside length of hospital stay. Data were anonymised and analysed using a multiple linear regression model. RESULTS: A total of 3,544 knee and 3,277 hip replacements were included. No association was found between length of stay and day of surgery for either procedure. A significant association was noted between longer length of stay and increasing age, higher American Society of Anesthesiologists grade and male compared with female gender. DISCUSSION: No evidence of a weekend effect was identified. Certain patient factors predicted longer hospital stay and focussing additional resources on these patient groups may prove a useful strategy in reducing overall length of stay. CONCLUSIONS: Length of stay reduced across the time period included in this review while maintaining equality between the days of the week, which represents the successful management of weekend services.
Subject(s)
Arthroplasty, Replacement, Hip/statistics & numerical data , Arthroplasty, Replacement, Knee/statistics & numerical data , Elective Surgical Procedures/statistics & numerical data , Adult , Age Factors , Aged , Aged, 80 and over , Arthroplasty, Replacement, Hip/adverse effects , Arthroplasty, Replacement, Knee/adverse effects , Elective Surgical Procedures/adverse effects , Female , Humans , Length of Stay/statistics & numerical data , Male , Middle Aged , Personnel Staffing and Scheduling , Prospective Studies , Risk Factors , Time Factors , Young AdultABSTRACT
The AO 8mm unreamed tibial nail (UTN) is an established implant that has in some publications been associated with high rate of distal locking screw breakage and failure. Larger reamed nails are now increasingly favoured. We have used the 8mm UTN employing all three available distal screws when appropriate and with a restricted initial weight-bearing regimen. Our experience has been satisfactory with 95% union rate and no adverse effect of distal locking screw breakage. This slender nail requires less frequent reaming which may be an advantage in at least some situations. We suggest that it should be considered an alternative to larger reamed nails and can perform satisfactorily with appropriate application.
Subject(s)
Bone Nails , Fracture Fixation, Intramedullary/instrumentation , Tibial Fractures/surgery , Adult , Aged , Aged, 80 and over , Female , Fracture Fixation, Intramedullary/methods , Fracture Healing , Humans , Male , Middle Aged , Prosthesis FailureABSTRACT
The results of 100 'Long Gamma Nails' (LGN) inserted in 97 patients, for the treatment of complex proximal femoral fractures and pathological lesions, are reported. The mean patient age was 74 (16-98). Seven significant complications occurred; four lag screws cut out, one broken nail, one infected non-union and one peri-prosthetic fracture. Five patients underwent revision either to total hip arthroplasty or exchange nailing. Seventy patients had follow-up of greater than 2 months (mean 10.8 months). Success was defined as stability of the fracture until union or death; this was achieved in 85% of cases. The mortality was 10% at 30 days and 25% at 1 year. The complication rate fell with increasing experience. Complex proximal femoral fractures are difficult to treat with all implants demonstrating high complication rates. The long gamma nail allowed early weight bearing and was effective in 85% of cases. Malpositioning of the implant should be avoided, as this was the leading cause of failure. Surgeon experience is an important factor but training of surgeons does not adversely affect outcome.
Subject(s)
Bone Nails , Femoral Fractures/surgery , Adolescent , Adult , Aged , Aged, 80 and over , Clinical Competence , Equipment Design , Equipment Failure , Female , Fracture Fixation/instrumentation , Fracture Fixation/methods , Fracture Fixation, Intramedullary/methods , Humans , Male , Middle Aged , Postoperative Complications/etiology , Reoperation , Retrospective Studies , Treatment OutcomeABSTRACT
Following total hip arthroplasty (THA) and total knee arthroplasty (TKR) only the 'visible' measured blood loss is usually known. This underestimates the 'true' total loss, as some loss is 'hidden'. Correct management of blood loss should take hidden loss into account. We studied 101 THAs and 101 TKAs (with re-infusion of drained blood). Following THA, the mean total loss was 1510 ml and the hidden loss 471 ml (26%). Following TKA, the mean total loss was 1498 ml. The hidden loss was 765 ml (49%). Obesity made no difference with either operation. THA involves a small hidden loss, the total loss being 1.3 times that measured. However, following TKA, there may be substantial hidden blood loss due to bleeding into the tissues and residual blood in the joint. The true total loss can be determined by doubling the measured loss.
Subject(s)
Arthroplasty, Replacement, Hip/adverse effects , Arthroplasty, Replacement, Knee/adverse effects , Blood Loss, Surgical , Aged , Blood Transfusion, Autologous , Female , Hemoglobins/metabolism , Hemostasis, Surgical , Humans , Male , Middle Aged , Prospective StudiesABSTRACT
A hospital radiology reports database was used to determine the prevalence of non-union of scaphoid fractures. Radiographs taken for any indication were used. By using a large number of radiographs, variations attributable to bias were minimised. There was a 0.14% prevalence of established scaphoid fracture non-union in the general population, indicating that unrecognised scaphoid non-union is rare.
