The Operating Theatre Journal April 2022

More documents

Recommendations

Info

Multiple long-term conditions should not be abarrier to hip replacement surgeryHaving multiple long-termconditions should not preventpeople with osteoarthritishaving hip replacements. Newresearch found that the surgeryimproved their quality of life andcomplication rates were generallylow. Despite this, the study foundthat fewer than half of thosewith hip osteoarthritis had hipreplacement surgery.Osteoarthritis is a commontype of arthritis that causespain and stiffness. In severecases, hip replacement surgeryis recommended. However,surgery might be delayed, oreven ruled out, if the person hasother existing health conditions.Such decisions are not based onevidence; the researchers say noprevious research has exploredwhether people with multiplelong-term conditions have worseoutcomes than others after thisprocedure.This study analysed the healthrecords of 27,560 people aged 65and over, who all had a diagnosisof hip osteoarthritis. Decisions onsurgery were influenced by longtermconditions, the study found;the more long-term conditionspeople had, the less likely theywere to have a hip replacement.Yet these people generally hadgood outcomes and benefittedfrom surgery.The research highlights theimportance of an evidencebasedapproach. The researchershope their work will help informdoctors and patients about therelative risks and benefits of hipreplacement surgery.What’s the issue?People with osteoarthritis havejoints that are painful, stiff, andsometimes swollen. This happenswhen the protective cartilage onthe ends of bones breaks down.It most often affects the knees,hips and small joints of the handsand is the most common type ofarthritis in the UK.When symptoms are mild, theycan be managed with regularexercise, weight management orwith special devices to reduce thestrain on joints during everydayactivities. If symptoms get worse,people may need painkillers or astructured exercise plan with aphysiotherapist.In severe osteoarthritis, peoplecan have surgery to completelyreplace the hip or other affectedjoint. Hip replacement surgerygenerally gives people a greaterrange of movement and reducestheir pain.People having hip replacementsare 70 years old, on average. Bythis age, many have other longtermconditions, such as highblood pressure or diabetes, whichmight increase the risk of anysurgery. Doctors may therefore beconcerned about recommendinghip replacement surgery for olderpeople who have such conditions.Researchers explored howmultiple long-term conditionsinfluence the likelihood and timingof hip-replacement surgery. Theyalso looked at the impact ofmultiple long-term conditions onthe outcomes of hip replacementsurgery.What’s new?The researchers analysed GPhealth records from across the UK.They included data from 27,560people aged 65 years and older.Participants had an average ageof 75 years and most (62%) werewomen. All had a diagnosis of hiposteoarthritis in their records.The team assessed participants’general health through thenumber of other conditions,and medications mentioned intheir records, and the numberof primary care consultations inthe preceding 12 months. Thereis no single way to measureother conditions; the researchersassessed conditions usingdifferent approaches, including ameasure of frailty.Are You Linkedin ?Join our GroupThe Operating Theatre Journalin TMHospital records showed thatfewer than half (40%) theparticipants underwent hipreplacement surgery.In the whole group, whichincluded people with and withoutmultiple long-term conditions,the study found:People with more long-termconditions were less likely to havehip replacement surgery, even ifthey had moderate poor health,and the benefits of surgeryoutweighed the risksNeither age nor gender affectedthe rate of surgery, whichsuggested that surgery waswithheld because of the longtermconditions the people had,and not these other factorsEven people who were ‘mildlyfrail’ were less likely to have thesurgeryMost surgery took place 10 monthsafter a diagnosis was added to GPrecords, but the more pre-existinglong-term conditions a personhad, the longer they waited.In a group of 6682 people with hiposteoarthritis and multiple longtermconditions, the researcherslooked at the outcomes of hipreplacement surgery.They found that:Regardless of pre-existingconditions, patients reportedimproved quality of life 6 monthsafter surgeryOther conditions weakly predictedrisk of complications (such as aheart attack or wound infection)but the increases in risk weresmallPeople with worse health beforesurgery were more likely to havecomplications afterwards, thoughthe complication rates (3%) anddeath rates (1%) were lowPeople’s health before surgerydid not influence how long theystayed in hospital; but those withworse health before surgery weretwice as likely to be readmittedto hospital afterwards than thehealthiest people in the studygroup.The researchers concluded that,for most people, having multiplelong-term conditions shouldnot be a barrier to having hipreplacementsurgery.Why is this important?Professionals and patientsboth raise concerns about hipreplacementsurgery when peoplehave other long-term conditions.This research provides evidenceabout the risks and benefits ofhip-replacement surgery for thisgroup of people.It found that hip-replacementsurgery improves quality of liferegardless of someone’s otherconditions. The surgery couldimprove some other conditions,such as depression, because ofthe improvement in pain. Theteam would like to follow peopleup for longer, to understand thelonger-term impact of surgery inpeople with multiple long-termconditions.The findings from this study showthat healthcare professionals andpatients should decide togetheron the benefits of surgery tothem. They should discuss therisks, including of anaesthesia,and jointly come to a decisionbased on evidence.The researchers say that, as longas the risk of having a generalanaesthetic is not too high, havingmultiple long-term conditionsshould not be a barrier to hipsurgery.What’s next?These results depend on theaccuracy of primary carehealth records. If a diagnosiswas included in the medicalrecords some time after the firstsymptoms appeared, people mayhave been suffering with pain forlonger than the records suggest.People with multiple long-termconditions did not stay in hospitalany longer than other people aftersurgery. It is possible that thelength of stay could be influencedmore by type of procedure.Surgery carried out under localanaesthetic might have shorterhospital stays than those carriedout under general anaesthetic.You may be interested to readOne of the papers this NIHR Alertis based on: Ferguson R, andothers. Influence of pre-existingmultimorbidity on receiving a hiparthroplasty: cohort study of 28 025elderly subjects from UK primarycare. BMJ Open 2021;11:e046713Another paper this NIHR Alert isbased on: Ferguson R, and others.Does pre-existing morbidityinfluences risks and benefits of totalhip replacement for osteoarthritis:a prospective study of 6682 patientsfrom linked national datasets inEngland. BMJ Open 2021;11:e046712Published on 11 March 2022doi:10.3310/alert_493022 THE OPERATING THEATRE JOURNAL www.otjonline.com
THE THETHESEPTEMBER APRIL 2020 2022 2020 ISSUE NO. NO. NO. 360 360 379 ISSN 0000-000X 1747-728XSEPTEMBER 2020 ISSUE NO. 360 ISSN 0000-000XThe The Operating Theatre Theatre JournalJournalOTJONLINE.COM £2.00OTJONLINE.COM£2.00The The Leading Leading Independent Print Print & Digital & Digital Journal Journal For For ALL ALL Operating Theatre Theatre StaffStaffThe Leading Independent Print & Digital Journal For ALL Operating Theatre StaffRCEM responds to public’s dissatisfaction with A&E services and wider NHSThe British Social Attitudes Survey by Nuffield Trust and The King’s Fund found that overall satisfaction withthe NHS fell to 36 per cent “an unprecedented 17 percentage point decrease on 2020” and “the lowest levelof satisfaction recorded since 1997, when satisfaction fell to 34 per cent.”The reasons for the fall in satisfaction are given as:- Waiting times for GP and hospital appointments (65%)- Staff shortages (46%)Royal College ofEmergency Medicine- A view that the government does not spend enough money on the NHS (40%)Satisfaction with Accident and Emergency Services fell by 15 percentage points, from 54% to 39%. Respondingto this fall Dr Katherine Henderson, President of The Royal College of Emergency Medicine, said:“It is disheartening to see that satisfaction with Accident and Emergency services has fallen to its lowestsince a question on A&E was introduced in 1999, a fall of 15 percentage points from 54% to 39%. Sadly,though, it is not surprising. For months we have been highlighting the crisis that Urgent and EmergencyCare services are facing, the significant threats to patient safety, the moral injury facing staff, the crowdedEmergency Departments and long waiting times and the danger these pose.”“This has been met with little to no action by the UK Government. We have called for an Urgent andEmergency Care recovery plan to tackle the crisis and improve the situation, what we have been given aretents in carparks outside Emergency Departments.“The dissatisfaction that the public feel with A&E services is understandable, Emergency Medicine staff arealso wholly dissatisfied and tired of being unable to deliver the high-quality effective care they are trainedto provide because of the lack of beds and staff in Emergency Departments, and the indifference shown bythe UK Government.“I commend all Emergency Medicine staff and all of The Royal College’s membership for their resilience andtireless efforts to do their best to keep patients safe and minimize harm in Emergency Departments in theseextremely challenging and trying circumstances. The present state of Urgent and Emergency Care is dire, buttheir efforts are preventing the system from tipping completely.”RCEM welcomes the publication of three reportsinto clinical negligence published by NHS ResolutionDr Katherine Henderson, President of the Royal College of Emergency Medicine, said:“We welcome these reports as learning opportunities to reduce the tragedy of preventable harm to individualsand their families as well as the staff involved. As specialty leaders and standard setters, we must use thestories and themes identified in these reports to focus our guidance and teaching and sharpen our advocacyfor a better system of care modelled to deliver patient needs.“Reports like these highlight the gap between what should be the standard of care and the operationalpressures the urgent and emergency care system is working under. While the responsibility for both ensuringEmergency Departments are adequately staffed with staff trained and qualified in Emergency Medicine andhave the equipment needed and access to relevant inpatient specialties lies with those who plan healthcareservices, every clinician must look through reports like these.“We must all think how we can eliminate patient harm by improving our knowledge and skills, teach others,advocate for better diagnostic pathways and safety net systems. We must also get better at communicatingrisk and uncertainty realities to patients, so they feel involved and confident to return for review if things donot seem to be following the expected plan.“The Royal College is committed to doing everything it can to improve patient safety and reduce the use ofresources needed to manage patient harm.”Further reading:https://resolution.nhs.uk/2022/03/28/learning-from-emergency-medicine-compensation-claims/Inside this issueNew research shows SurgicalSite Infection prevention,and achieving First-PassRecanalization in MechanicalThrombectomy could lead toenvironmental benefits for theNHSP4University gets governmentbacking for multi-million-poundhealthcare skills hub refurbP7NAO Investigation into themanagement of PPE contractsP8New BAOMS Council membersbring diversity and strong skillsP9First of a kind study evidenceseffectiveness of MFAT on painand improved joint functionP10Novel nuclear microRNA is beingdeveloped for the treatment ofcardiovascular diseaseP12Saintonge becomes first hospitalin France to install the Dexter®surgical robotP14Nurse saves man’s lifeP16ODP Andrew Verrecchia winsthe Keir Hardie AwardP16Liquid biopsy offers new toolsfor detecting recurrent breastcancerP17Cleveland Clinic Expands itsGlobal Footprint with Openingof London HospitalP18Detecting possible signs ofstroke quickly and reliablyP20More Than AI: What OtherTechnological DevelomentsHave Improved SurgeryP20BAOMS New Model Hospitalclinical OMFS performancedata goes liveP21Jobs boost for Cork as privatehospital group announcesnational expansionP21WHO Risk of medicationerrors with tranexamic acidP22Find out more 02921 680068 • e-mail admin@lawrand.com Issue 379 April 2022 3
Page 1: THE THETHESEPTEMBER APRIL 2020 2022
Page 5 and 6: Patient Positioning Solutions for H
Page 7 and 8: Six-use day cuffsReusable cuffsWe
Page 9 and 10: New BAOMS Council members bringdive
Page 11 and 12: Theatre staff vacanciesPractice Plu
Page 13 and 14: THESEPTEMBER 2020 ISSUE NO. 360 ISS
Page 15 and 16: #StepForwardWEEKENDTHEATREWORK...Fa
Page 17 and 18: Congratulations, you are now readin
Page 19 and 20: www.OperatinggTheatreJobs.comA one-
Page 21 and 22: The Operating Theatre JournalDiscov
Page 23: Your firstchoicein activehumidifica

The Operating Theatre Journal April 2022

Create successful ePaper yourself

Delete template?

Save as template?