District General Hospital Experience Research Articles

EGS SO12 - A District General Hospital experience for setting up a "Hot Gallbladder" pathwayBackground

Abstract Background This project details a quality improvement initiative at Chesterfield Royal Hospital (CRH) to establish a “Hot Gallbladder” pathway (HGP) amidst immense NHS pressures. Before this service, CRH performed emergency cholecystectomies solely in an NCEPOD emergency theatre shared with other specialities, resulting in low case volumes, unpredictability, long patient waiting times with extended inpatient stays. The new service now dedicates two half-day lists per week to suitable patients admitted acutely and managed by five dedicated surgeons. Method This quality improvement project involves two separate yearly retrospective audits analysing patients who underwent gallbladder removal through the HGP in 2022 and 2023 at CRH. The primary objective was to assess the HGP's efficacy in terms of the number of cases performed and list completion (2 cases per half-day list). The secondary objective evaluatedadherence to the HGP protocol, appropriate patient selection, indications, and completion of adequate pre-operative investigations. The final objective assessed the HGP's safety by comparing incidence of complications and length of stay with patients undergoing cholecystectomy on the emergency NCEPOD list. Results 268 patients had gallbladder removal through the HGP and 84 cases in the emergencyNCEPOD theatre. The median age was 51, with a 3:1 female-to-male ratio. 75% of patients were managed through surgical ambulatory care. The HGP saw a 30% increase in cases and list completion rates rose from 41% to 61% in one year. NCEPOD emergency theatre usage reduced to 37%. All patients had appropriate indications and pre-operative investigations. 70% of cholecystitis patients were operated within 7 days. The HGP had a lower complication rate (6.2%) compared to emergencies (8%) and shorter post-operative stays (2 days vs 2.5 days). Conclusion This project demonstrates the benefits of establishing a HGP in a DGH. Inpatient stays were significantly reduced as 75% of patients were managed through the ambulatory carepathway. This led to financial benefits and greater patient satisfaction. Timely operations by dedicated surgeons resulted in a lower complication rate and shorter length of stay. The pathway increased the number of cases performed. The reduction in emergency theatre cases allowed better care for patients requiring emergency theatre access.

FP8.11 - Surgical Site Infection Post-operation (gowning vs not gowning): A District General Hospital Experience

Abstract Aims Increasing evidence shows that surgical site infection (SSI) does not differ significantly between main operation theatre and field sterility for many surgical procedures. This audit aimed to assess the rate of surgical site infection (comparing the operating surgeon using a disposable gown vs not using one) for emergency/elective skin procedures like uncomplicated incision and drainage of abscess, excision of lipoma, sebaceous cyst, and pilonidal sinus. Methods The electronic database was used to collect data (September-October 2023) on the type of surgery performed, number of theatre staff scrubbed in. Poster displays and informal education were used to raise awareness of theatre wastage (November 2023). All were advised to wear an apron, mask, sterile gloves, and field sterility only for uncomplicated cases. Data was recollected (December 2023-January 2024). Results 54 cases were performed in September and October 2023. All theatre staff scrubbed in and 160 gowns were used. 5/54 (9.3%) returned with wound infection and managed with antibiotics. The median of the number of days in which the patients returned post-operatively is 7 days. 24 cases were performed from December 2023-January 2024. Theatre staff in 5/24 cases did not scrub in and none of these patients returned with wound infection. Out of the other 17/24 cases, 5/17 (29.4%) returned with wound infection. Conclusions With the limitation of small sample size and multi-factorial aetiology of wound infection, surgeons who did not gown up had no increased risk of wound infection. The higher monetary and environmental costs of complete gowning without improvement of patients’ care are unjustifiable.

The economic and resource burden of e-scooter-related orthopaedic injuries: A district general hospital's experience

PurposeElectric scooters (e-scooters) are an increasingly popular method of transportation worldwide. However, there are concerns regarding their safety, specifically with regards to orthopaedic injuries. We aimed to investigate the overall burden and financial impact on orthopaedic services as a result of e-scooter-related orthopaedic injuries. MethodsWe retrospectively identified all e-scooter-related injuries requiring orthopaedic admission or surgical intervention in a large District General Hospital in England over a 16-month period between September 2020 and December 2021. Injuries sustained, surgical management, inpatient stay and resources used were calculated. ResultsSeventy-nine patients presented with orthopaedic injuries as a result of e-scooter transportation with a mean age of 30.1 years (SD 11.6), of which 62 were males and 17 were females. A total of 86 individual orthopaedic injuries were sustained, with fractures being the most common type of injury. Of these, 23 patients required 28 individual surgical procedures. The combined theatre and recovery time of these procedures was 5500 min, while isolated operating time was 2088 min. The total cost of theatre running time for these patients was estimated at £77,000. A total of 17 patients required hospital admission under Trauma and Orthopaedics, which accounted for total combined stay of 99 days with a mean length of stay of 5.8 days. ConclusionWhile there are potential environmental benefits to e-scooters, we demonstrate the risks of injury associated with their use and the associated increased burden to the healthcare system through additional emergency attendances, frequent outpatient clinic appointments, surgical procedures, and hospital inpatient admissions.

Outcomes of Percutaneous Image-Guided and Laparoscopic Cholecystostomies in High-Risk Patients With Acute Calculus Cholecystitis: A Five-Year District General Hospital Experience.

Introduction Acute cholecystitis (AC), inflammation of the gall bladder, is one of the most common emergency surgical presentations. In the UK, approximately 15% of the population is estimated to have gallstones, and approximately 20% of them can develop AC. Laparoscopic cholecystectomy (LC) is considered the definitive management of AC. However, cholecystectomy carries a very high risk of morbidity and mortality in high-risk frail patients with multiple comorbidities who are deemed unfit for surgery. Percutaneous cholecystostomy (PC), both image-guided and laparoscopic, is generally acknowledged as an interim treatment measure before definitive management, which is the LC. Materials and methods This is a retrospective study from the Royal Albert Edward Infirmary, a district general hospital (DGH) based in Wigan, UK. The medical records of all the patients whowere admitted to the surgical department and underwent PC between January 2017 and December 2022 were analyzed. Patients with previous hepato-pancreato-biliary (HPB) malignancy, who underwent open cholecystostomy, or those withabdominal ascites were excluded from the study. Information was collected regarding the age, gender, American Society of Anaesthesiologists(ASA) grades, success rates of both procedures as temporary or definitive management, duration of hospital stay, 30-day and 1-year mortality after the procedure, timing of the procedure,and long-term complications after the procedure, particularly those related to cholecystostomy tube dislodgment or blockage. Results Twenty-seven patients who underwent PCwere divided into two groups: group A, consisting of 10 patients who underwent laparoscopic cholecystostomies, and group B, consisting of 17 patients who had ultrasound (US)-guided cholecystostomies.The mean age of the patients in group A was 66.7 as compared to 75.1 in group B.Most of the patients were in ASAgroups III (14) and IV (10). About 74% of patients had procedures done during the day and 26% had PC at night time. The mean hospital stay was 13.5 days. About 55% of patients had planned elective LC as a definitive management. Following the treatment, two patients died within 30 days, and eight patients passed away within a year. About 40% of the patients had complications related to the tube dislodgment and blockage. Conclusion This study concludesthat PC, using both laparoscopic and US-guided techniques, can serve as an interim as well as a definitive measure,particularly in patients who are at high risk for anesthesia and the procedure itself and have multiple comorbidities.

New onset atrial fibrillation – optimising electrocardiographic diagnostic accuracy and appropriate anticoagulation: a district general hospital experience

New onset atrial fibrillation – optimising electrocardiographic diagnostic accuracy and appropriate anticoagulation: a district general hospital experience

The provision of parenteral nutrition during the Covid-19 pandemic: A district general hospital experience.

The provision of parenteral nutrition during the Covid-19 pandemic: A district general hospital experience.

640 Ambulatory Ultrasound - Could We Be More Efficient? Re-Audit -a District General Hospital Experience

Abstract Aim Right iliac fossa (RIF) pain is a common presentation to General Surgery departments and appendicitis is a possible cause. There are diagnostic challenges in these patients. Over a fifth undergoing appendicectomy have a histologically normal appendix (1). National guidelines recommend performing Ultrasound Scans (USS) in select patients (2). Aim is to review if there is better use of a limited service. Method A retrospective review of all ambulatory USS from June - December 2020 comparing to data from June 2019 - December 2019 for RIF/lower abdominal pain. We collected demographics, working diagnoses, imaging request details and outcomes. Results 109 patients were included. 106 were female and 3 males. Of these, 35 had a working diagnosis of ovarian/ gynaecology pathology, whilst 25 had one of ‘appendicitis vs gynaecological pathology’. The USS was reported as no abnormality detected in 73 patients. 94(86%) had matching working diagnosis to USS request (41% in 1st audit). 22 (20%) had a working diagnosis matched with USS results (13%). In total 101 patients were discharged – there were 5 admissions (3 CT scans + 2 laparoscopic appendicectomies) and 3 referrals onwards to gynaecology. Conclusions We recommend using USS pelvis in women of childbearing age to identify gynaecological causes of RIF pain, more focused requests in order reduce requests of abdominal USS in lower abdominal pain, males should only receive hot clinic scans for biliary concerns, and increased use of CT for females >40 years old.

153 - A district general hospital experience of targeted lung health check pilot

153 - A district general hospital experience of targeted lung health check pilot

Pulmonary hypertension, pulmonary embolism and COVID-19: A district general hospital experience from the UK.

Preliminary data suggest that the prevalence of pulmonary hypertension (PH) in patients with COVID-19 is around 13%, but its prognostic role remains unclear. Approximately 3% of patients develop chronic thrombo-embolic pulmonary hypertension (CTEPH) following diagnosis of acute pulmonary embolism (PE). It is recommended that patients are screened for CTEPH if they remain symptomatic 3 months following diagnosis of PE. The primary aim of the study was to assess the chances of persistent PH following PE secondary to COVID-19. We conducted a retrospective cohort study at a District General Hospital (DGH) in the United Kingdom. All patients diagnosed with COVID-19 and PE between April 2020 and October 2021 were examined. Patients were divided into two groups:·COVID-19 and PE with comorbidities (excluding pre-existing PH) and·COVID-19 and PE without comorbidities. We compared the ECHO features suggestive of PH between the two groups at the time of diagnosis of PE and at 3 months following treatment. 80 patients were included in the study (49 with comorbidities and 31 with no comorbidities). Average age of comorbidities and no comorbidities groups were 73 years and 70 years, respectively. Average PaO2/FiO2 ratio for comorbidities and no comorbidities groups were 170 and 195, respectively. Fourteen patients (13 with comorbidities and 1 with no comorbidities) died in total. Results showed that risk of persistent PH and subsequent mortality following PE in COVID-19 is 4.17 times and 1.32 times more in comorbidity group as compared to no comorbidity group, respectively (p < 0.001). Patients with comorbidities are at high risk of persistent PH and mortality due to PE secondary to COVID-19.

1037 The Use of Fluorescence Angiography with Indocyanine Green in Colorectal Surgery – A District General Hospital Experience

Abstract Introduction Indocyanine green (ICG) fluorescence imaging is used in a variety of procedures in in colorectal surgery. It optimises intraoperative vision of anatomical structures by improving blood and lymphatic flow. Traditionally, the vascularization of the colonic stump is subjectively evaluated by the surgeon based on the colour of the bowel wall, the bleeding of the colonic stump, and pulsation of the terminal artery. ICG aims to improve objectivity of this assessment. Aim To assess the feasibility and efficacy of ICG in colorectal operations and report on initial experience since introduction in November 2021. Method Retrospective review of prospectively collected database of all patients undergoing colorectal operations with intraoperative ICG use for any indication. Data collected included patient demographic details including age/gender/comorbidities; operative details including indication/type of surgery, 30day-complications, details/outcome of intraoperative ICG use. Results During the study period ten patients underwent colorectal surgical procedures with intra-operative use of ICG. Surgical options included resectional surgery (right hemicolectomy/transverse colectomy/anterior resection) and reconstructive surgery (reversal of hartmann's operation). Majority were done for colorectal cancer and one for inflammatory bowel disease. ICG was reported useful in all cases in demonstrating vascularity in anastomoses/resection margins. One notable case demonstrated decreased ability of discerning ICG uptake in the presence of tattoo pigmentation (preoperative tumour marking). No adverse events were reported. Conclusion The ICG assessment of colonic vascularization was simple, feasible, with no adverse events in our cohort. Our experience suggests caution is required when interpreting ICG readings in the presence of colonic tattoo.

425 Extra-Anatomical Detour Ureteric Stents: Our District General Hospital Experience of 50 Patients with a Minimum Follow Up of 6 Months

Abstract Aim Extra-Anatomical Detour Stents offer a viable modality of decompression particularly in the context of malignancies; with the absent need for changes of stents, cosmetically better than nephrostomies and fewer admissions associated with blockages/infections. Our aim was to assess the safety and feasibility of performing detour stents in a district general hospital. Method A review of prospectively collected data on all patients undergoing detour stents between 2016 and 2021 was undertaken. This enabled a possible follow up period of 6 months, provided the patients remained alive. A statistical package was utilised for the analysis of the collected data. Results Fifty patients were identified to have undergone detour stent insertion with malignancy being the indication in 90% of cases. Seven patients required a further eleven procedures with the most common being due to repositioning of the stent (36%) or change of stent due to infection (27%). Four patients passed away within 60 days of their procedure. Four patients had their stents eventually replaced with nephrostomies and a patient no longer required the detour stent due to resolution of their obstructive pathology. Nine patients are currently being followed up and thirty-six patients from the original cohort passed away with functional detour stents. Their median survival time post-procedure was 164 days. Conclusions Extra-Anatomical Detour Stents offers patients with obstructing renal tract secondary to malignancy a better quality of life when compared with nephrostomy. Continued caseload and refinement of surgical technique would lead to further optimised surgical outcomes.

TU4.3 Caecal volvulus: A District General Hospital Experience and Review of the Literature

Abstract Aim Caecal volvulus (CV) is an uncommon cause of large bowel obstruction with potential for complications such as ischaemia, and perforation. Prompt diagnosis and treatment only will ensure better outcomes. We aim to describe our experience in the largest series of CV reported in the United Kingdom. Methodology This was a retrospective study of 16 consecutive patients diagnosed with CV between March 2017 and March 2020. Results Out of 16 patients, 11 were female, with a median age of 64 (range 33–80) years. All patients presented with abdominal pain and vomiting. An initial diagnosis of bowel obstruction was made only in 8 patients (50%). Computed tomography (CT) scan of the abdomen and pelvis correctly diagnosed CV in fourteen (87.5%). Fifteen patients (94%) underwent surgical intervention. All but one (n=14,93.4%) underwent laparotomy, and one patient (6.6%) underwent successful laparoscopic intervention. Right hemicolectomy was performed in all operated patients, and fourteen patients (93.4%) had primary anastomosis. Twelve patients (80%) had one or other form of morbidity. Seven patients (47%) and three patients (20%) had grade II and III (Clavien-Dindo Classification) complications respectively with a median hospital stay of 10 (range 1–49) days. One patient (6.7%) managed conservatively was deemed to be futile. There was no postoperative mortality. Conclusion CV can present with non-specific symptoms, and a definite preoperative diagnosis is only possible with the aid of CT. Open resectional procedures with primary anastomosis is the most favoured approach in management, though laparoscopic access is also feasible in fit patients.

SP8.1.1 Emergency Vs Elective Common Bile Duct Exploration, A District General Hospital Experience over 6 years

Abstract Introduction Laparoscopic Common bile duct exploration (LCBDE) is a relatively new approach for clearing choledocholithiasis. The aim of this study is to assess the feasibility of this approach to clearing CBD stones in an emergency setting. Methods Retrospective data collection and analysis was carried out for 207 consecutive cases of LCBDE performed over 6 years (2015–2020). The patients were divided into two groups according to the operation performed as an emergency or elective. We compared demographics, perioperative data, post-operative complications, and outcomes. Results 207 cases of LCBDE were performed during the time period. 122 performed as an emergency, and 85 on an elective list. Of the emergency cases, 37 performed because of cholangitis either mild or moderate in severity according to Tokyo grading system. Ninety-six percent of the emergency cases and 94.1% of the elective cases were completed laparoscopically. Length of stay post-operatively was 3.3 +6.3 days in the emergency and 3.5 +4.6 days after elective. Successful clearance achieved at the end of the operation in 99% of the patients in the emergency group, clearance failed in one case. In the elective group 100% of the patients has a successful clearance at the end of the operation. Twelve patients (emergency) and 8 patients of the elective cases required post-operative ERCP to manage retained stones, recurrent stones or bile leak (p=0.921). Three patient required re-operation for post operative complications in each group. Conclusion Common bile duct exploration in emergency settings is feasible, with high success rate if performed by surgeons with advanced laparoscopic biliary skills.

Very low event rate and few device implants in drug-induced brugada. A seven-year experience of ajmaline challenge at a district general hospital

Abstract Funding Acknowledgements Type of funding sources: None. Background Patients with a drug-induced Brugada electrocardiogram (ECG) are thought to have a lower risk of sudden cardiac death than those with a spontaneous type 1 ECG. Despite having a Brugada ECG, most patients do not need an implantable cardioverter defibrillator (ICD). Purpose To report a district general hospital experience on referral and outcomes of ajmaline challenge (AC) with medium term follow up. Methods 92 consecutive patients (50 males, mean age 41 ±17) had an AC in a single centre from 2014-2021. High ventricular leads were used from 2015. Ajmaline (1m/kg) was administered intravenously over 10-minutes. Data were collected from the electronic health record. Results The AC was positive in 18 (20%) patients. The yield from high leads was higher (7% vs 22%) p=0.28) but not statistically significant. There were no deaths or documented ventricular arrhythmias (VA) in AC positive patients during a median follow up of 3.2 years (1.7-4.9). The resting ECG was normal in 46.7%. A type 1 pattern had been provoked by fever or electrolyte derangements in 3.3%, type 2 pattern in 8.7% and a type 3 pattern in 5.4%. An RSR pattern (not in keeping with a BrS ECG) was seen in 26.4%. The test was stopped prematurely due to QRS widening &amp;gt;150ms in 1 patient. No adverse arrhythmic events occurred (table 1). In our cohort, positive AC patients were older (48y vs 37y p= 0.05) and more likely to have a type 2 (28% vs 4% p=0.007) or type 3 ECG (17% vs 3% p=0.05). Asymptomatic patients were more likely to have a normal ECG (22% vs 78% p=0.05) Of those with a positive AC, nine patients had symptoms of palpitations or syncope (table 2). A subcutaneous ICD (S-ICD) was implanted for syncope in two patients. No device therapies have occurred during a follow up of 2.5 years and 3.9 years respectively. Of those with a positive AC but asymptomatic, one S-ICD was initially implanted due to patient preference. A second S-ICD was implanted in a patient who experienced a collapse and brief seizure in the context of modest alcohol consumption. In seven positive patients (39%) and 18 negative patients (23%) an ILR was implanted. 1 episode of complete heart block was detected in an ajmaline negative patient during a median follow up of 2.7 years (1.7-3.9). There were no device related complications or adverse events. Conclusion AC is safe with a low number of device implants and ICD shocks. The yield from ILR implants was very low. A single patient had a potentially adverse outcome after consuming alcohol, a known trigger for VA in BrS. Our findings are in keeping with contemporary evidence that suggests the risk of adverse cardiac events in drug-induced BrS is low. However, time to first ICD shock may occur after ten years or more from diagnosis so long term follow up is required.

Caecal Volvulus: A District General Hospital Experience and Review of the Literature

Background: Caecal volvulus (CV) is an uncommon cause of large bowel obstruction with potential for complications such as ischaemia and perforation. Prompt diagnosis and treatment only will ensure better outcomes. We aim to describe our experience in the largest series of CV reported in the United Kingdom. Methods: This was a retrospective study of 16 consecutive patients diagnosed with CV between March 2017 and March 2020. Results: Out of 16 patients, 11 were female, with a median age of 64 (range 33–80) years. All patients presented with abdominal pain and vomiting. An initial diagnosis of bowel obstruction was made only in 8 patients (50%). Computed tomography (CT) scan of the abdomen and pelvis correctly diagnosed CV in fourteen (87.5%). Fifteen patients (94%) underwent surgical intervention. All but one (n = 14, 93.4%) underwent laparotomy, and one patient (6.6%) underwent successful laparoscopic intervention. Right hemicolectomy was performed in all operated patients, and fourteen patients (93.4%) had primary anastomosis. Twelve patients (80%) had one or another form of morbidity. Seven patients (47%) and three patients (20%) had grade II and III (Clavien–Dindo Classification) complications, respectively, with a median hospital stay of 10 (range 1–49) days. One patient (6.7%) managed conservatively was deemed to be futile. There was no postoperative mortality. Conclusions: CV can present with non-specific symptoms, and a definite preoperative diagnosis is only possible with the aid of CT. Open resectional procedures with primary anastomosis are the most favoured approach in management, though laparoscopic access is also feasible in fit patients.

243 How to Reduce Breaches of Trauma &amp; Orthopaedics Patients in the Emergency Department: A District General Hospital Experience

Abstract Aim The handbook to the NHS constitution for England pledges a maximum four-hour wait in the Emergency Department (ED) from arrival to admission, transfer, or discharge. We present a closed-loop audit of ED waiting times for patients admitted under Trauma and Orthopaedics (T&amp;O), before and after implementation of a change in practice, with the aim of reducing the number of patients that breached the four-hour target. Method An initial single-centre audit of patients that were admitted under T&amp;O through ED was undertaken (25/11/2019 – 02/12/2019). All stakeholders were educated on audit findings through departmental meetings. Protocols were updated and new guidelines were synthesised and implemented in collaboration between the ED and T&amp;O departments. Waiting times were re-audited (21/06/2021 – 28/06/2021). Data was collected retrospectively from clinical e-documentation. Results 57 patients were included in the initial audit and 51 patients in the loop closure. The total number of breaches improved from 86% to 65% (p &amp;lt; 0.05). The first audit highlighted that the biggest cause of breaches was ‘waiting for an ED review’ (56%) followed by ‘waiting for over thirty minutes for a bed’ (28%). Following our intervention, breaches due to ‘waiting for an ED review’ reduced (28%) and the biggest cause of breaches changed to ‘waiting for over thirty minutes for a bed’ (45%). Conclusions Our closed-loop audit identified that improved formalised protocols for ED referrals to specialities and clinical guidelines agreed upon by both parties (ED and T&amp;O) reduces the number of breaches in ED.

Evaluation of pathological response rates following neoadjuvant systemic therapy: 5-year district general hospital experience

Background: Neoadjuvant chemotherapy prior to breast cancer surgery may be offered for a number of reasons. These include making an inoperable tumour operable, enabling breast conserving surgery, improve overall survival and observing clinical response. The response to neoadjuvant treatment for triple-negative (TNC) and human epidermal growth factor receptor 2-positive (HER2+) can be a prognostic indicator on the likelihood of breast cancer recurrence. We evaluated pathological response (pCR) rates in our study including ER+/HER2-, TNC and HER2+ subgroups.

Observational study of clinico-radiological follow-up of COVID-19 pneumonia: a district general hospital experience in the UK

BackgroundThe British Thoracic Society (BTS) recommends that all patients admitted with COVID-19 pneumonia should have a chest X-ray (CXR) and clinical follow-up at 6 or 12 weeks, depending on the disease severity. Little data is available on long-term CXR follow-up for moderate and severe COVID-19 pneumonia. This study aims to evaluate compliance with clinico-radiological follow-up of patients recovering from COVID-19 pneumonia at a local hospital in the UK, as per the BTS guidance, and to analyse radiological changes at clinical follow-up at 12 weeks, in order to risk-stratify and improve patient outcomes.MethodsThis is a single-centre retrospective audit of 255 consecutive COVID-19 positive patients admitted to a local hospital in the UK over 5 months between May and October 2020. All CXRs and clinic follow-up at 12 ± 8 weeks were checked on an electronic database.ResultsOver one in two (131/255) patients had CXR evidence of COVID-19 pneumonia during the initial hospital admission. Half of the patients (60/131) died before CXR or clinic follow-up. Fifty-eight percent (41/71) of the surviving patients had a follow-up CXR, and only two developed respiratory complications- one had residual lung fibrosis, another a pulmonary embolism. Eighty-eight percent (36/41) of the patients had either resolution or improved radiological changes at follow-up. Most patients who had abnormal follow-up CXR were symptomatic (6/8), and many asymptomatic patients at follow-up had a normal CXR (10/12).ConclusionsAlthough there were concerns about interstitial lung disease (ILD) incidence in patients with COVID-19 pneumonia, most of our patients with COVID-19 pneumonia had no pulmonary complications at follow-up with CXR. This emphasises that CXR, a cost-effective investigation, can be used to risk-stratify patients for long term pulmonary complications following their COVID-19 pneumonia. However, we acknowledge the limitations of a low CXR and clinic follow-up rate in our cohort.

Limb Length Inequality in Patients After Primary Total Hip Arthroplasty: Analysis of Radiological Assessment and Influencing Risk Factors Based on a District General Hospital Experience of 338 Cases.

Background and objectiveLimb length inequality (LLI) is a frequent and recurring issue after total hip arthroplasty (THA). It is often a source of patient dissatisfaction and litigation. This study reviewed the incidence of LLI in a UK District General Hospital in light of published evidence and identified the preoperative and intraoperative risk factors for LLI.MethodsThis was a retrospective study involving 380 consecutive unilateral primary total hip replacements over a period of 12 months. Patient demographics, clinical, radiological, and operative details were collected from the National Joint Registry (NJR) database and hospital records. The limb length was measured radiologically [OrthoView WorkstationTM (Materialise UK, Southampton, UK)], pre- and postoperatively, by two authors. They assessed the vertical distance between the intra-acetabular teardrop line and the medial apex of the lesser trochanters. After excluding complex primary, revision cases, tilted X-rays, and hip replacement for trauma patients, 338 cases were included in the final analysis.ResultsThe mean postoperative LLI was 2.7 mm with a standard deviation (SD) of 6.56 mm. Only 5.3% of patients had LLI >15 mm. None of the studied variables showed a statistically significant correlation with LLI. Even with the apparent difference in the mean LLI between templating and not templating before surgery (2.19 vs. 3.53), the p-value was 0.06, which was below the level of statistical significance. There was a weakly positive Pearson correlation between body mass index (BMI) and the incidence of lengthening of the limb.ConclusionThe cause of LLI after THA is multifactorial. No single factor can be singled out as the most significant contributor to this complication.

EP.FRI.300 Equine related trauma: a 20-year district general hospital experience

Abstract Introduction Although a popular recreational and competitive sport, horse riding carries risk of injury. We aimed to characterise demographics, injury patterns and outcomes of patients with an equine-related injury over a 20-year period. Methods Patients were identified through local coding. Data relevant to the study aims were extracted. Statistical analysis was used to determine any association between patient demographic with injury pattern or outcome. Results Of the 701 patients included, 71.3% were female and the mean age was 34.9 years. Simple head injury (25.4%) and upper limb fracture (21.3%) were the commonest injuries. Abdominal visceral injury occurred in 1.6% with 2 patients requiring laparotomy and splenectomy. Overall, operations were performed in 32.8%. Open reduction and internal fixation was the commonest procedure (42.4%). 30-day mortality was 0.3% and 3.1% required transfer to a tertiary centre. Older patients were more likely to have a rib (46.3 vs 33.5 years, p = &amp;lt;0.05) or lower limb fracture (37.9 vs 34.5 years, p = 0.04) whilst upper limb fractures were seen in younger patients (30.3 vs 36.1 years, p = &amp;lt;0.05). There was no statistical difference with other injury patterns or gender. Conclusion Although mortality is rare, a significant proportion of patients sustain injury requiring surgical intervention. Given the predisposition towards orthopaedic injury, adequate rehabilitation facilities need to be available. Continued development and promotion of safety equipment are also required to reduced incidence.