Body Mass Index and Time to Mobilise Post Primary Total HIP Arthroplasty

Abstract

s / International Journal of Surgery 8 (2010) 501–578 519 cases referred to an upper GI unit in a large DGH for consideration for bariatric surgery over a three year period. Data was obtained for 71 patients with mean BMI 53.2 kg/m2. According to NICE guidelines 89% patients fulfilled criteria for consideration for bariatric surgery, with 63% fulfilling criteria for consideration as “first-line” management. All suitable patients were referred to the regional NHS commissioning body but only one patient received weight loss surgery. We estimate that if all patients in our series meeting NICE “first-line” criteria underwent surgery there would be net healthcare savings of £1,134,000 in the first ten postoperative years, which if extrapolated for the region rises to savings of £6,048,000 per year. Although the majority of referred patients are suitable very few are offered surgery despite significant cost-savings over the medium to long term. Increased availability of bariatric surgical services in the NHS is needed to improve the health of patients and reduce the financial burden of obesity-related disease. BODY MASS INDEX AND TIME TO MOBILISE POST PRIMARY TOTAL HIP ARTHROPLASTY E.C. Toll , G.C. Bannister . 1 Department of Plastic and Reconstructive Surgery, Frenchay Hospital, Bristol, UK; Avon Orthopaedic Centre, Southmead Hospital, Bristol, UK Introduction: High body mass index (BMI) may prolong a patient's hospital stay following elective joint replacement surgery due to delayed progression of mobility post-operatively. The aim of this study is to examine any relationship between body mass index and progression of mobility following primary total hip arthroplasty. Methods: The time taken to initially get out of bed, start mobilisation, confidently mobilise with sticks, negotiate stairs safely and to be discharged from inpatient physiotherapy was recorded for 110 consecutive patients undergoing primary total hip arthroplasty in one unit. Spearman's rhowas used to identify any relationships between BMI and the time taken to achieve each of these mobility milestones. Results: No significant relationships were found between BMI and the time taken to reach each of the five mobility milestones. Spearman's rho (day got up) 1⁄4 0.138, p 1⁄4 1.59; Spearman's rho (mobilised 1⁄4 0.72, p 1⁄4 0.462; Spearman's rho (mobilised with sticks) 1⁄4 0.101, p 1⁄4 0.301; Spearman's rho (stairs complete) 1⁄4 0.76, p 1⁄4 0.790; Spearman's rho (inpatient physiotherapy complete) 1⁄4 0.58, p 1⁄4 0.578. Conclusions: Increasing BMI appears to cause no delay in post-operative mobilisation following primary total hip arthroplasty. High BMI should therefore not be the sole reason for excluding patients from receiving elective total hip arthroplasty. FRAGILITY FRACTURE PREVENTION AT A PRIMARY CARE LEVEL Jonathan Evans. Royal United Hospital Bath NHS Trust, UK Aim: To audit the risk stratification and subsequent secondary prevention of osteoporosis in women over the age of 65 with a history of fragility fractures. Audit standards guided by the National Osteoporosis Guideline Group and the governmental Direct Enhanced Service agreement. Risk stratification achieved using the FRAX assessment tool for osteoporosis. Method: All female patients aged over 65 with a history of fragility fracture retrospectively analysed using the practice database. Multiple data abstracted relating to fracture risk. Assessment of DEXA guided diagnosis. Risk analysed using the FRAX tool. Current treatment compared to that recommended through guidelines and level of risk. Results: N 1⁄4 51. Age range 65–96. Subdivided into 76yrs. Proportion of 76 receiving bone sparing therapy 1⁄4 31.6%(100%). Poor recording of osteoporosis risk factors. Average 10yr risk of major fracture1⁄4 26.4%, of hip fracture1⁄4 12%. 5 high-risk patients identified, all under treated. Conclusion: Osteoporosis targets are clearly not being reached. Risk stratification is not being undertaken and cost effective secondary prevention is not being utilised effectively. The FRAX tool has validated utility and should be implemented into patient work up following fracture. ADULT HAND LACERATIONSHOW ACCURATE IS OUR DIAGNOSIS? Santosh Venkatachalam, Patrick Gillespie, Fortune Iwuagwu. St Andrew's center for Hand injuries, Broomfield, Chelmsford Hand injuries rank as second most common category in AE Peritoneal Surface