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Clinical efficacy and cost-effectiveness of intra-operative cell salvage in pelvic trauma surgery
Abstracts / Injury Extra 42 (2011) 95–169
Purpose of the study: To evaluate the mobility, discharge destination, presence of back pain and length of stay of patients who sustained combined pubic rami and SOFs and to identify the significance of this association. Methods: We prospectively studied 67 patients with low-impact pubic rami and/or SOFs over 12 months. The patients were over 60 years of age and were assessed by the fracture liaison service. MR imaging or bone scan were done when there was back pain or lumbo-sacral tenderness. Results: There were 54 (80.4%) female and 13 (19.6%) male patients and the average age was 87.5 years (range 65–96). The mean length of stay was 45 (±35) days. Mortality rate was 10.4%. There was a significant relationship between low back pain and the presence of sacral fracture. Patients with combined pubic rami and SOFs showed significantly longer length of stay than those with isolated pubic rami fractures. Conclusion: We recommend considering the high association between SOFs and pubic rami fractures and the presence of back pain in planning the management of patients with POFs and their rehabilitation, which would potentially exhaust resources, due to their significantly increased length of stay and reduced mobility. doi:10.1016/j.injury.2011.06.290 1B.39 Clinical efficacy and cost-effectiveness of intra-operative cell salvage in pelvic trauma surgery S. Odak, A. Raza, N. Shah, A. Clayson Wrightington Hospital, United Kingdom Introduction: Pelvi-acetabular injuries are associated with significant blood loss. This is further compounded by multiple surgical interventions undertaken including definitive fracture fixation which put patients at further risk of post-operative transfusion. We routinely use intra-operative cell salvage as a blood conservation strategy to address this issue. This is a prospective evaluation of clinical efficacy and cost-effectiveness of using intra-operative cell-salvage in patients with pelvi-acetabular injuries. Materials and methods: Data was collected prospectively in all the patients who underwent pelvi-acetabular fracture fixation at our institution. A total of 30 patients (25 males, 5 females) with a mean age of 41 years (range 31–79 years) were assessed over a period of 10 months. Results: Mean pre-operative and post-operative haemoglobin was 11.8 and 9.9 respectively. Mean intraoperative blood loss was 1232.5 ml (range 150–2693 ml). Mean amount of blood salvaged and re-transfused through cell-saver was 388 ml. 14 patients (47%) required transfusion after surgery and a total of 26 units of blood were transfused. In terms of cost-effectiveness a total of £2572 in 30 patients or £85.73 per patient were saved. Conclusion: We found intra-operative cell salvage to be clinically efficacious and cost-effective in patients with pelvi-acetabular injuries. doi:10.1016/j.injury.2011.06.291
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1B.40 Long term radiological findings after Pubic Symphysiotomy J.G. Galbraith 1 , J.F. Baker 1 , K.P. Murphy 2 , G.B. Mullan 1 , J.A. Harty 1 1
Department of Trauma and Orthopaedic Surgery, Cork University Hospital, Wilton, Cork, Ireland 2 Department of Radiology, Cork University Hospital, Wilton, Cork, Ireland Introduction: Pubic Symphysiotomy (PS) is a controversial procedure that was commonly performed in Ireland for cases of obstructed labour up to 1964. Complications including pelvic pain and instability, has led to it now only being practiced in certain developing countries where caesarean section is not available. However, a recent Cochrane review suggests that PS may still have a place in modern obstetric practice. If obstetricians re-establish this practice then orthopaedic surgeons may have a role in the prevention of associated late complications. Several authors have already reported successful outcomes following open reduction and internal fixation in cases of spontaneous pubic symphyseal disruption after childbirth. The purpose of this paper is to report the long-term clinical and radiological findings after PS. Methods: Patients presenting to the orthopaedic clinic with complications following PS over a three-year period (2005–2007) were identified using chart data. All patients were assessed clinically and radiologically. Age and parity matched controls were randomly selected from the hospital radiology database to compare radiological findings. Results: Twenty-five women presented to clinic with orthopaedic complications following PS. The mean age was 68.7 years (range 53–84) and mean number of deliveries was 4.7 (range 2–10). The mean follow-up was 41.6 years. Common complaints included lower back pain (n = 25) and gait abnormalities (n = 7). Radiologically, the pubic symphysis gap was significantly greater in the PS group (mean 12 mm, range 5–42 mm), compared to the control group (mean 4.1 mm, range 2–7 mm) (p < 0.05). Displacement of the pubic symphysis was present in 7 PS patients. Sacroiliac joint (n = 12) and hip joint arthritis were also more common in the PS group. Conclusions: Pubic Symphysiotomy can result in abnormalities of gait, pelvic pain and lower back pain. If this procedure re-emerges in obstetric practice, then orthopaedic surgeons may have a role in preventing these complications through operative stabilisation. doi:10.1016/j.injury.2011.06.292 1B.41 The management of ankle fractures at a general hospital and the potential health economics of initial home therapy M. Ricks, H. Dabis, R. Karthigan Department of Trauma and Orthopaedics, St Helier Hospital, Carshalton, London, UK Introduction: Ankle fractures are common presentations to Accident and emergency departments and a significant proportion go onto have an operation. Swelling in particular is a well recognised complication of the injury and frequently leads to the delay of an operation. A recent paper published by Lloyd et al.1 highlights the cost effectiveness of sending patients home who have sustained ankle fractures and are too swollen for an operation. It allowed them to free up bed spaces and save money for the trust. It was decided that it would be appropriate to assess the length of stay at a south London district general hospital and whether it would be
Purpose of the study: To evaluate the mobility, discharge destination, presence of back pain and length of stay of patients who sustained combined pubic rami and SOFs and to identify the significance of this association. Methods: We prospectively studied 67 patients with low-impact pubic rami and/or SOFs over 12 months. The patients were over 60 years of age and were assessed by the fracture liaison service. MR imaging or bone scan were done when there was back pain or lumbo-sacral tenderness. Results: There were 54 (80.4%) female and 13 (19.6%) male patients and the average age was 87.5 years (range 65–96). The mean length of stay was 45 (±35) days. Mortality rate was 10.4%. There was a significant relationship between low back pain and the presence of sacral fracture. Patients with combined pubic rami and SOFs showed significantly longer length of stay than those with isolated pubic rami fractures. Conclusion: We recommend considering the high association between SOFs and pubic rami fractures and the presence of back pain in planning the management of patients with POFs and their rehabilitation, which would potentially exhaust resources, due to their significantly increased length of stay and reduced mobility. doi:10.1016/j.injury.2011.06.290 1B.39 Clinical efficacy and cost-effectiveness of intra-operative cell salvage in pelvic trauma surgery S. Odak, A. Raza, N. Shah, A. Clayson Wrightington Hospital, United Kingdom Introduction: Pelvi-acetabular injuries are associated with significant blood loss. This is further compounded by multiple surgical interventions undertaken including definitive fracture fixation which put patients at further risk of post-operative transfusion. We routinely use intra-operative cell salvage as a blood conservation strategy to address this issue. This is a prospective evaluation of clinical efficacy and cost-effectiveness of using intra-operative cell-salvage in patients with pelvi-acetabular injuries. Materials and methods: Data was collected prospectively in all the patients who underwent pelvi-acetabular fracture fixation at our institution. A total of 30 patients (25 males, 5 females) with a mean age of 41 years (range 31–79 years) were assessed over a period of 10 months. Results: Mean pre-operative and post-operative haemoglobin was 11.8 and 9.9 respectively. Mean intraoperative blood loss was 1232.5 ml (range 150–2693 ml). Mean amount of blood salvaged and re-transfused through cell-saver was 388 ml. 14 patients (47%) required transfusion after surgery and a total of 26 units of blood were transfused. In terms of cost-effectiveness a total of £2572 in 30 patients or £85.73 per patient were saved. Conclusion: We found intra-operative cell salvage to be clinically efficacious and cost-effective in patients with pelvi-acetabular injuries. doi:10.1016/j.injury.2011.06.291
127
1B.40 Long term radiological findings after Pubic Symphysiotomy J.G. Galbraith 1 , J.F. Baker 1 , K.P. Murphy 2 , G.B. Mullan 1 , J.A. Harty 1 1
Department of Trauma and Orthopaedic Surgery, Cork University Hospital, Wilton, Cork, Ireland 2 Department of Radiology, Cork University Hospital, Wilton, Cork, Ireland Introduction: Pubic Symphysiotomy (PS) is a controversial procedure that was commonly performed in Ireland for cases of obstructed labour up to 1964. Complications including pelvic pain and instability, has led to it now only being practiced in certain developing countries where caesarean section is not available. However, a recent Cochrane review suggests that PS may still have a place in modern obstetric practice. If obstetricians re-establish this practice then orthopaedic surgeons may have a role in the prevention of associated late complications. Several authors have already reported successful outcomes following open reduction and internal fixation in cases of spontaneous pubic symphyseal disruption after childbirth. The purpose of this paper is to report the long-term clinical and radiological findings after PS. Methods: Patients presenting to the orthopaedic clinic with complications following PS over a three-year period (2005–2007) were identified using chart data. All patients were assessed clinically and radiologically. Age and parity matched controls were randomly selected from the hospital radiology database to compare radiological findings. Results: Twenty-five women presented to clinic with orthopaedic complications following PS. The mean age was 68.7 years (range 53–84) and mean number of deliveries was 4.7 (range 2–10). The mean follow-up was 41.6 years. Common complaints included lower back pain (n = 25) and gait abnormalities (n = 7). Radiologically, the pubic symphysis gap was significantly greater in the PS group (mean 12 mm, range 5–42 mm), compared to the control group (mean 4.1 mm, range 2–7 mm) (p < 0.05). Displacement of the pubic symphysis was present in 7 PS patients. Sacroiliac joint (n = 12) and hip joint arthritis were also more common in the PS group. Conclusions: Pubic Symphysiotomy can result in abnormalities of gait, pelvic pain and lower back pain. If this procedure re-emerges in obstetric practice, then orthopaedic surgeons may have a role in preventing these complications through operative stabilisation. doi:10.1016/j.injury.2011.06.292 1B.41 The management of ankle fractures at a general hospital and the potential health economics of initial home therapy M. Ricks, H. Dabis, R. Karthigan Department of Trauma and Orthopaedics, St Helier Hospital, Carshalton, London, UK Introduction: Ankle fractures are common presentations to Accident and emergency departments and a significant proportion go onto have an operation. Swelling in particular is a well recognised complication of the injury and frequently leads to the delay of an operation. A recent paper published by Lloyd et al.1 highlights the cost effectiveness of sending patients home who have sustained ankle fractures and are too swollen for an operation. It allowed them to free up bed spaces and save money for the trust. It was decided that it would be appropriate to assess the length of stay at a south London district general hospital and whether it would be