Unsatisfactory post-operative trauma imaging is predictive of revision surgery

Abstract

Introduction This study aimed to assess the relationship between immediate post-operative imaging and the risk of revision surgery for mechanical failure, as well as to determine the effect of routine peer review of post-operative imaging on the rate of unsatisfactory radiological outcomes and revision surgery. Methods Two trauma fellowship-trained consultants reviewed all post-operative images prior to the department adopting a metalwork multidisciplinary team and judged whether the surgery was satisfactory or not. Trauma lists and imaging were reviewed for a 90-day follow-up period to determine if a patient had required revision surgery. Following analysis a daily review was introduced where a consensus decision was reached regarding the fixation. A further 90-day follow-up period was utilised to determine the subsequent rate of revision surgery. Results In the first cohort 977 cases were identified with an overall revision rate of 2.5%, 875 cases having satisfactory imaging (89.6%) and 102 unsatisfactory (10.4%). Revision rates were 0.5% and 19.6%, respectively. Following introduction of the daily peer review process 709 cases were identified with an overall revision rate of 1.6%, 664 cases had satisfactory imaging (93.7%) and 45 unsatisfactory (6.3%). Revision rates were 0.5% and 17.8%, respectively. Patients with unsatisfactory imaging were significantly more likely to require a revision ( p < 0.0001). There was a significant drop of 4% in the rate of unsatisfactory imaging between the two cohorts. Conclusion Unsatisfactory post-trauma imaging can be predictive of the need for revision surgery and peer review of imaging should form part of continuous clinical governance.