Orthopaedic Inpatients Research Articles

Epidemiology of geriatric orthopaedic injuries in a tertiary hospital in southwestern Nigeria

Life expectancy in sub-Saharan Africa (SSA) has increased owing to economic growth and improvements in medical care. An increased representation of older people among orthopaedic trauma victims is a significant consequence of population ageing, as shown in previous studies, including few in SSA. This retrospective review in Nigeria aims to corroborate previous studies and highlight the emergence of geriatric orthopaedic trauma (GOT) as a public health concern in SSA. Among 241 orthopaedic trauma in-patients aged ≥ 60, the mortality rate was 3.7%. They made up 21.2% of adult orthopaedic trauma admissions. The incidence of GOT increased steadily over the five-year study period with a spike during COVID-19 lockdown. Males constituted 51%. Mean age was 72.5 years (range, 60–105 years). Mean distance to the hospital was 35.8 km and 50.6% lived farther than 10 km. The main causes of injury were falls (50.6%) and traffic crashes (48.1%). Fractures were the predominant (91.7%) injuries. Univariate analyses revealed significant differences along age and gender stratifications. Longer distance to the hospital significantly delayed presentation. The study supports previous studies and shows that GOT is evolving as a public health concern in SSA. The 2030 Sustainable Development agenda is apt to stem the trend.

Pharmacoepidemiology of Drugs Used in Indoor Patients of Orthopaedic Department at a Tertiary Care Hospital

Background: Globally, with the increasing orthopaedic admissions, the management modalities have also been evolving. With the focus mainly on reducing hospital stay and improving quality of life, pharmacotherapy is a keystone in management. Thus, the present study was undertaken to assess the drug utilization in orthopaedic inpatients. Methods: This is a cross sectional, observational study carried out over a period of one year from April 2021 to April 2022. Data was collected from prescriptions of 200 patients admitted in the Orthopaedic ward and evaluated for WHO Drug Use Indicators and potential drug-drug interactions (pDDI) and prescription pattern was noted. Adverse Drug Reactions (ADR) were noted and assessed. Results: A total of 2046 drugs were prescribed in 200 prescriptions. Average number of drugs per prescription is 10.23. Antimicrobials (25.76%) was the most common class of drug prescribed followed by supplements (20.28%) and analgesics (16.13%). 79.42% drugs were prescribed by generic name, 82.06% were from the National List of Essential Medicines (NLEM) and 99.9% drugs were from hospital pharmacy. Antibiotics prescribed were as per WHO AWaRe guidelines. ADR noted in 4 patients with drug being discontinued in one case. pDDI were seen in 98% prescriptions with 95.8% being Pharmacokinetic interactions. Conclusion: Current study provides insight into the drug utilisation pattern, highlighting the extensive use of antibiotics and analgesics in orthopaedic inpatients. Adherence to WHO guidelines helps reduce antibiotic resistance and promotes better patient care.

Incidence of acute Deep Vein Thrombosis in pediatric and adolescent orthopedic trauma hospitalized patients and effect of rivaroxaban treatment

ObjectiveDeep vein thrombosis (DVT) provoked by orthopedic trauma is increasing in pediatric hospitalized patients. The purpose of our study is to identify the prevalence of acute DVT in pediatric and adolescent orthopedic trauma hospitalized patients and focus on evaluating the anticoagulation strategies and the clinical outcomes after a confirmed acute DVT. MethodsPatients (age ≤18 years) with a confirmed acute DVT admitted for orthopedic trauma between September 2017 and December 2023 were included. Patients were classified into the non-anticoagulation (NA), the in-hospital anticoagulation (IHA), and the in-and-out-of-hospital anticoagulation (IOHA) groups based on their anticoagulation regimen. Efficacy outcomes were the venous thromboembolism (VTE) recurrence within 3 months and change in thrombus burden by repeat imaging at 2 weeks after discharge compared with baseline. Safety outcomes were major bleeding (MB) and clinically relevant non-major bleeding (CRNMB) within 3 months. ResultsOf the 11,206 pediatric and adolescent orthopedic trauma inpatients, 94(median age,16 [15, 18] years) were diagnosed with acute DVT, with an incidence of 0.84 %, of which 8(8.5 %) received NA, 41(43.6 %) received IHA, and 45(47.9 %) received IOHA. After the diagnosis of DVT, of patients who received anticoagulation, 97.9 % were treated with rivaroxaban as an oral anticoagulant, and 71.7 % received an LMWH course of ≥5 days before starting rivaroxaban therapy. With a median anticoagulation course of 22(8, 37.3) days, the duration in the IOHA was significantly longer than the IHA (37 days vs. 8 days, p = 0.000). No patients experienced recurrent VTE and MB at 3 months, and 1 received IOHA had a CRNMB event (0 % vs. 0 % vs. 2.2 %, p = 1.000). Thrombus resolution was significantly higher in patients who received anticoagulation therapy (IOHA 91.1 % vs. IHA 80.5 % vs. NA 37.5 %, P = 0.002), and thrombus-no relevant change was significantly lower in patients who received the IOHA strategy compared with the other groups (4.4 % vs. 19.5 % vs. 62.5 %, P = 0.000). ConclusionsA rivaroxaban-predominant IOHA strategy significantly reduced the thrombotic burden without increasing the risk of bleeding for the treatment of DVT in adolescents with orthopedic trauma. Duration of anticoagulation therapy <6 weeks appears appropriate for adolescent orthopedic trauma-related DVT.

Accelerated decline in motor suppression in patients with cerebrovascular disorders: A kinetic analysis using the square-tracing task.

Patients with cerebrovascular disorders (CVDs) tend to exhibit impulsive behaviour without controlling their movements, leading to difficulty in performing activities of daily living and an increased risk of accidents. This hastiness, termed 'pacing impairment', has been studied but is not fully understood. To experimentally examine the kinetic features of pacing impairment by focusing on changes in speed and investigating neuropsychological substrates. We instructed 53 inpatients with CVDs, 20 orthopaedic inpatients, and 20 healthy participants to trace a 200 mm-sided square as slowly as possible for 120 seconds. We measured the tracing length and mean acceleration and examined the relationship between these measurements, neuropsychological symptoms, and lesion sites. Gradual acceleration in drawing, i.e., decline in motor suppression, was observed more frequently in the CVD group than in the control groups. Excessive acceleration was associated with unilateral spatial neglect, frontal lobe signs, and attention disorders but not with motor impersistence. Additionally, the incidence of excessive acceleration did not differ between left and right hemisphere lesion subgroups and was not associated with any specific lesion site. Pacing impairment can manifest as general or holistic deficits in attentional function widely distributed throughout the cerebral hemispheres.

Retrospective Analysis of Nosocomial SARS-CoV-2 Infections in Orthopedic and Traumatological Inpatients.

SARS-CoV-2 has had a measurable impact on the field of orthopedic and traumatological surgery. To date, scarce data on intramural SARS-CoV-2 infections in orthopedic and traumatological patients have been reported. Therefore, the aim of our study was to investigate the effect of nosocomial SARS-CoV-2 infections in orthopedic and traumatological inpatients regarding symptoms of infection, mortality, duration of hospitalization, and other relevant patient-dependent factors. Patients admitted to hospital for an orthopedic or traumatological indication were screened retrospectively for nosocomial SARS-CoV-2 infections and included in this study. An age-, sex-, and ICD 10-matched control group was assigned and demographic data, clinical symptoms of a SARS-CoV-2 infection as well as mortality, length of hospital stays, time to surgery, pre-existing conditions, LKF-points representing the financial effort, and the Charlson Comorbidity Index were collected. A significantly higher length of stay was observed in the SARS-CoV-2 group (25 days; 4-60; SD 12.5) when compared to the control group (11 days; 2-36; SD 7; p < 0.05). LKF points were significantly higher in the SARS-CoV-2 group (13,939 points vs. 8542 points). No significant difference in mortality could be observed. An infection with SARS-CoV-2 in inpatients significantly increases length of hospital stay and cost of treatment. Although no significant difference in mortality was found, care should be taken to avoid intramural SARS-CoV-2 infections, resulting in prolonged hospitalization, higher costs, and potentially further individual risks.

Prevalence of psychiatric morbidity in orthopaedic inpatient: a hospital based cross-sectional study

Background: Identification of a psychiatric problem should be a necessity part of treatment planning in orthopedic practice, and prompt referral for diagnosis and treatment should be made for better outcome. There have been very few studies in Nepal that has assessed the presence of psychiatric disorders in injured inpatients. The aim of the study was to find out the prevalence of psychiatric disorders in patients with injury admitted to the orthopedic ward of CMC teaching hospital. Methods: The study was carried out among 150 randomly selected patients of age group 18-60 years from the orthopedic ward suffering from any orthopedic injury. The study design is a hospital based cross sectional descriptive study. Diagnosis of psychiatric Disorders were made using ICD10 criteria. Data entry and analysis was done using the SPSS software version 21.0. Results: The prevalence of psychiatric disorder in patients with orthopedic injury was found to be 32% with depressive disorders being the most common diagnosis (12.1%) followed by anxiety disorder (8%) and somatoform disorder(6%). Psychiatric disorders were significantly associated with age, age group and gender. Psychiatric disorders were the most commonly found in those with patients with road traffic accident (52.1%) and those with lower limb injury (47.9%). Conclusions: Since, there is presence of psychopathology in orthopedic injured patients, early referral by the orthopedic surgeons to the psychiatric department is necessary for early evaluation and treatment.

613 The Use of an Online Sepsis Screening Tool to Improve the Initial Management of Sepsis

Abstract Aim The aim of the project was to improve the adherence to sepsis management guidelines in Trauma and Orthopaedic patients through the use of an online Sepsis Screening Tool (SST). This was created to increase recognition of the early signs of sepsis to guide time critical interventions thus improving patient care. Method A retrospective audit of adult Trauma and Orthopaedic inpatients with a NEWS2 score of over 5, or 3 in one parameter, or a new suspected infection within a seven-day period was conducted in July 2020, March 2021 and August 2021 for each audit cycle respectively. We then assessed whether the SST and time critical interventions had been completed. Results After the initial audit in July 2020 showed the use of the SST and achievement of time critical interventions was poor, we introduced several interventions including information posters, and sepsis teaching for junior doctors. Further interventions were implemented after repeat audit cycles, including the incorporation of the SST within daily nursing safety huddles. By August 2021 the use of the SST had increased from 10% to 54%. This was associated with improved adherence to the sepsis management guidelines including correct observation frequency and medical review within 1 hour. Communication of a sepsis diagnosis to patients and family members also improved. Conclusions The completion of the SST increased adherence to sepsis management guidelines in our patients. We therefore recommend the use of Sepsis Screening Tools to identify patients at risk of sepsis and to improve their initial management.

Deep vein thrombosis and validation of the Caprini risk assessment model in Chinese orthopaedic trauma patients: a multi-center retrospective cohort study enrolling 34,893 patients

BackgroundThe risk of venous thromboembolism among orthopaedic trauma patients is high, but prevalence of deep vein thrombosis (DVT) remains unknown. In addition, the Caprini risk assessment model (RAM) score in orthopaedic trauma patients is undetermined in previous research. This study is aimed to determine the incidence of DVT and then validate the Caprini RAM in orthopaedic trauma patients.MethodsThis is a retrospective cohort study enrolling orthopaedic trauma inpatients from seven tertiary and secondary hospitals during a 3-year period (from April 1, 2018 through April 30, 2021). Caprini RAM scores were assessed by experienced nurses on admission. The patients with suspected DVT were verified through duplex ultrasonography by qualified radiologists, and then prospectively followed once a year after discharge.ResultsIn total, 34,893 patients were enrolled in our study. The Caprini RAM identified 45.7% of patients at low risk (Caprini score 0–2), 25.9% at medium risk (3–4), and 28.3% at high risk (5–6), highest risk (7–8), and superhigh risk (> 8). Patients with Caprini score > 5 were likely to be older, female, and with longer length of hospital stay. Moreover, 8695 patients had received ultrasonography to detect DVT. The prevalence of DVT was determined to be 19.0% [95% confidence interval (CI) 18.2–19.9%], which significantly increased with Caprini score. The area under curve of the Caprini RAM for DVT was 0.77 (95% CI 0.76–0.78) with a threshold of 4.5. Furthermore, 6108 patients who had received ultrasonography completed the follow-up. DVT patients had a hazard ratio of 1.75 (95% CI 1.11–2.76; P = 0.005) in the mortality, compared to non-DVT ones. Caprini scores were significantly associated with increase in the mortality [odds ratio (OR) 1.14; 95% CI 1.07–1.21; P < 0.001]; DVT remained an independent effect (OR 1.5; 95% CI 1.02–2.26; P = 0.042).ConclusionsThe Caprini RAM may be valid in Chinese orthopaedic trauma patients. Prevalence of DVT and higher Caprini score were significantly associated with increased all-cause mortality among orthopaedic trauma patients after discharge. Further study is warranted to explore the causes of higher mortality in patients with DVT.

Feasibility and acceptability of a virtual clinical pharmacy service for elective orthopaedic inpatients in an Australian metropolitan hospital

AbstractBackgroundVirtual healthcare services are usually provided from urban centres to outpatient clinics or underserved rural areas. This study utilises virtual pharmacy as an innovative model to provide services to a metropolitan hospital from a rural area.AimThis study assesses the feasibility, and patient and staff acceptability of a Virtual Clinical Pharmacy Service (VCPS) in a tertiary metropolitan hospital ward with limited on‐site clinical pharmacy services.MethodPharmacists from a rural health district provided telepharmacy services for nine weeks. Data on service provision and detection of medication‐related issues were captured in the electronic health record. Service acceptability was assessed through a staff focus group and patient acceptability by a patient‐reported experience measures (PREM) survey. Ethical approval was granted by the Greater Western Human Research Ethics Committee (Reference no: 2021/ETH00097).ResultsThe VCPS demonstrated high utilisation, with 535 clinical and medication reviews provided for 225 patients. Virtual medication reviews identified 151 medication‐related issues or recommendations. PREM surveys (n = 22) were supportive of the VCPS model. Staff valued the service and reported ease of access to specialist medication advice and confidence that patient medications were correct. Staff raised patient confidentiality in open wards and lack of experience using virtual healthcare as barriers to the implementation.ConclusionFeasibility was demonstrated by high service utilisation, detection of medication‐related issues, and measures of acceptability from patients and staff. The VCPS offers a solution to enhance sustainability and service agility by delivery of clinical services when face‐to‐face is not practicable or available. Further research is required to demonstrate efficacy and to confirm patient acceptability.

Characteristics of inpatients with newly diagnosed multiple myeloma in hematology, nephrology, and orthopedic departments.

To describe the characteristics of multiple myeloma (MM) by retrospectively analyzing data from patients with MM in hematology, nephrology, and orthopedic departments, we selected inpatients diagnosed with MM for the first time who were admitted to the hematology department of Taizhou Hospital of Zhejiang Province between January 1, 2017, and June 30, 2021 ([Formula: see text]) and those admitted to the nephrology ([Formula: see text]) and orthopedic ([Formula: see text]) departments of Taizhou Hospital of Zhejiang Province between January 1, 2010, and June 30, 2021. For patients with MM initially diagnosed in the nephrology or orthopedic departments, age- and sex-matched patients without MM were randomly selected in a 1:1 ratio. Conditional logistic regression models were used to assess the risk of MM in hospitalized patients in the nephrology and orthopedic departments. This study included 200 patients, with a median age of 65years. There were differences among patients in the three departments with respect to fracture, degree of anemia, proteinuria levels, red blood cell (RBC) count, hemoglobin levels, total protein (TP) levels, albumin levels, and laboratory indicators of renal function. TP levels > 68.45g/L were independent risk factors for patients in the nephrology department (odds ratio (OR) = 1.01, 95% confidence interval (CI) = 1.001-1.024, P = 0.04), and RBC count < 3.79 × 1012/L was an independent risk factor for orthopedic inpatients (OR = 0.49, 95% CI 0.268-0.913, P = 0.02). Therefore, nephrologists should pay attention to the TP level of hospitalized patients to facilitate the early identification of MM in patients with chronic kidney disease. Orthopedic surgeons should pay attention to RBC counts in patients with fractures, and patients with low RBC counts should avoid unnecessary surgery and move to specialist care as early as possible.

Development of the Self-Perceived Safety of Orthopedic Post-Surgery Inpatients (SPSOPSI) Scale.

In recent decades, patient safety in orthopedics has gained increasing importance and has been regarded as a core concept of medical care quality. However, according to currently published studies, measurement instruments used to evaluate post-surgery orthopedic patient's perceptions are still very rare. This study aimed to develop a new measurement instrument, the self-perceived safety of orthopedic post-surgery inpatients (SPSOPSI) scale, which can provide healthcare workers with a better understanding of orthopedic patients' self-perceived safety and give more precise clinical suggestions. Item analysis and exploratory factor analysis (EFA) were used, and the results showed that the six-factor model is good-fit: root mean square residual (RMR) 0.00, root mean square error of approximation (RMSEA) 0.06, goodness-of-fit index (GFI) 0.90, comparative fit index (CFI) 0.98, incremental fit index (IFI) 0.98. The results showed the SPSOPSI scale is a valid and reliable tool for health care providers can use to evaluate orthopedic post-surgery patients' perceived safety.

A Three-Step System to Ensure Correct Attribution of Named Clinicians for Inpatients.

Background: The Francis report recommends that all patients admitted into a UK hospital must have a named identifiable and suitably trained consultant or clinician in charge of their care. This is regarded as a shared responsibility as highlighted by the recommendations made by the General Medical Council Best Practice guidance. However, this can become more error-prone, particularly in acute trauma and orthopaedic inpatients when the named consultant may change numerous times.Methods: We conducted an audit reviewing all the inpatients in the acute trauma and orthopaedic wards and then reaudited twice following the introduction of the three-step system. The results were then analysed and compared with previous cycle results.Results: Initially following the introduction of the three-step system, there were poorer outcomes. Inpatients with the correct named consultant declined from 47% to 37%. However, following further education and training of each respective member of the multidisciplinary roles, the results were much improved with 88.9% of the inpatients having the correct named consultant.Conclusions: Ensuring that all inpatients have the correct named consultant is a shared responsibility amongst all health and social care staff involved with the patient. This audit highlights that attributing specific roles to relevant members of the multidisciplinary team can improve communications and patient care.

Risk Factors for Road-Traffic Injuries Associated with E-Bike: Case-Control and Case-Crossover Study.

The Electric Bike (EB) has become an ideal mode of transportation because of its simple operation, convenience, and because it is time saving, economical and environmentally friendly. However, electric bicycle road-traffic injuries (ERTIs) have become a road-traffic safety problem that needs to be solved urgently, bringing a huge burden to public health. In order to provide basic data and a theoretical basis for the prevention and control of ERTIs in Shantou, mixed research combining a case-control study and a case-crossover study was carried out to investigate the cycling behavior characteristics and injury status of EB riders in Shantou city, and to explore the influencing factors of ERTI. The case-control study selected the orthopedic inpatient departments of three general hospitals in Shantou. The case-crossover study was designed to assess the effect of brief exposure on the occurrence of ERTIs, in which each orthopedic inpatient serves as his or her own control. Univariable and multivariable logistic regressions were used to examine the associated factors of ERTIs. In the case-control study, multivariable analysis showed that chasing or playing when cycling, finding the vehicle breakdown but continuing cycling, not wearing the helmet, and retrograde cycling were risk factors of ERTIs. Compared with urban road sections, suburb and township road sections were more likely to result in ERTIs. Astigmatism was the protective factor of ERTI. The case-crossover study showed that answering the phone or making a call and not wearing a helmet while cycling increased the risk of ERTIs. Cycling in the motor-vehicle lane and cycling on the sidewalk were both protective factors. Therefore, the traffic management department should effectively implement the policy about wearing a helmet while cycling, increasing the helmet-wearing rate of EB cyclists, and resolutely eliminate illegal behaviors such as violating traffic lights and using mobile phones while cycling. Mixed lanes were high-incidence road sections of ERTIs. It was suggested that adding people-non-motor-vehicles/motor vehicles diversion and isolation facilities in the future to ensure smooth roads and safety would maximize the social economic and public health benefits of EB.

Influence of perioperative SARS-CoV-2 infection on mortality in orthopaedic inpatients with surgically treated traumatic fractures

BackgroundSARS-CoV-2 has had an extensive influence on orthopaedic surgery practice and has been associated with an increased risk of mortality. There is limited evidence of how this pertains to acute orthopaedic surgery with inpatient care.MethodsA retrospective cohort study on traumatic fracture patients requiring inpatient care between February 25, 2020 and March 25, 2021 was conducted. Patients were grouped by perioperative SARS-CoV-2 infection, defined as a positive SARS-CoV-2 test from 7 days before to 7 days after orthopaedic surgery, and compared using linear regression and Cox proportional hazards model for primary outcome 30-day mortality and secondary outcome hospital length of stay.ResultsIn total, 5174 adults with a length of stay ≥ 48 h and an orthopaedic procedure due to a registered traumatic fracture were admitted from February 25, 2020 and discharged before March 26, 2021. Among the 5174 patients, 65% (3340/5174) were female, 22% (1146/5174) were 60–74 years and 56% (2897/5174) were 75 years or older. In total, 144 (3%) had a perioperative SARS-CoV-2 infection. Perioperative SARS-CoV-2 infection was associated with an increased 30-day mortality (aOR 4.19 [95% CI 2.67–6.43], p < 0.001). The median (IQR) length of stay after surgery was 13 days (IQR 6–21) for patients with, and 7 days (IQR 2–13) for patients without, perioperative SARS-CoV-2 infection.ConclusionsPerioperative SARS-CoV-2 infection increased 30-day mortality risk and hospital length of stay for traumatic fracture patients requiring inpatient surgical care. Pre- and postoperative infection were both associated with similar increases in mortality risk.

Nutrition Intervention on Surgical Outcome Among Selected Hospitalized Subjects

Type 2 diabetes is a polygenetic disease in which environmental factors and obesity play a major role in disease development. When diabetes is not well managed, complications develop that threaten health and endanger life. People with diabetes are also likely to have chronic muscle-skeletal co-morbidities, especially pre and post operative malnutrition escalates the infection rate and longer stay in hospital. Orthopaedic patients with surgical bone fractures and hip surgeries presented a deteriorating nutritional status, and higher incidence of many health problems. Medical Nutritional Therapy (MNT) is an essential component of inpatients in terms of management of surgical outcome among the diabetic subjects. Hence the present intervention study focused on the incorporation of soy protein in the formulated health mix which was used for the preparation of selected breakfast recipes for the post operative lower limb injured Type 2 diabetic subjects. Impact of nutrition intervention on surgical outcome was analysed. Increase in pre albumin level and reduced surgical site infection and length of stay (p&lt;0.05) in hospital were proving that MNT is an essential component of inpatient which was usually unrecognized among orthopedic inpatients within a tertiary hospital. It was also evident from the study that the incorporation of high biological value protein along with the regular diet (which was easily included in the preparation of common recipes) of lower limb injured hospitalized Type 2 diabetics has significant impact on the increment in serum albumin along with an elevation of Total Lymphocyte TLC (&gt;15), markers of nutritional status insisting the importance of nutritional support as a prevention strategy to decrease the incidence post operative complications among orthopedic subjects.

Prevalence of depression and anxiety and associated factors among geriatric orthopedic trauma inpatients: A cross-sectional study.

BACKGROUNDCommon mental disorders such as anxiety and depression in geriatric orthopedic trauma patients have received little attention in research. AIMTo investigate the prevalence of emotional disorders among geriatric orthopedic trauma patients and identify demographic, social and clinical risk factors.METHODSThis cross-sectional study was performed in geriatric patients (aged ≥ 60 years, both sexes) with orthopedic trauma admitted to a level I trauma center between May 2015 and December 2017. Demographic, social, and clinical characteristics were described. Huaxi Emotional-Distress Index (HEI) was used to evaluate the severity of anxiety and depression status. Differences in continuous variables were tested using the t-test, and differences in categorical variables were assessed using the Pearson χ2 test. Binary logistic regression analyses were used to identify the factors associated with a HEI score > 8.RESULTSAmong the 966 patients, 487 were male and 479 were female, with a mean age of 70.2 ± 7.1 years. The age ranged from 60 to 90 years. Seventy-five patients had an HEI score > 8, accounting for about 7.8% of all patients. A higher Injury Severity Score (4.17 ± 3.10 vs 7.96 ± 6.68, P < 0.001), higher Visual Analog Score (5.05 ± 1.09 vs 6.89 ±1.23, P < 0.001), number of chronic diseases (P < 0.001), injury type (P = 0.038), and education level (P = 0.001) were significantly associated with HEI score > 8. On logistic regression, a higher education level was a protective factor for emotional disorders (P = 0.047), whereas Injury Severity Score (P = 0.024), Visual Analog Score (P < 0.001), two or more chronic diseases (P < 0.001) were the related independent risk factors. CONCLUSIONEmotional disorders are common in geriatric patients with orthopedic trauma. Clinicians should remain vigilant of emotional disorders in geriatric patients and screen for anxiety and depression in higher risk groups.

Multidisciplinary Team Deprescribing Intervention for Polypharmacy in Elderly Orthopedic Inpatients: A Propensity Score-matched Analysis of a Retrospective Cohort Study.

Objective This study evaluated the effectiveness of a multidisciplinary team deprescribing intervention to reduce polypharmacy and potentially inappropriate medications (PIMs) in elderly orthopedic inpatients. Methods In this single-center retrospective observational study, orthopedic inpatients ≥75 years old and prescribed ≥6 different medications were enrolled as participants. Interventions comprised multidisciplinary team-led polypharmacy screening and suggestions regarding deprescribing any unnecessary medications during hospital stays. The primary outcome was reduction in the mean number of regular medicines and PIMs. Secondary outcomes included falls, delirium, and other adverse events during hospitalization as well as emergency department visits or unplanned hospital admissions within six months after discharge. Results After propensity score matching, 184 patients (intervention group, n=92; control group, n=92) were included in the analysis. The mean patient age was 83 years old. The mean number of prescribed medications and PIMs at admission were similar in both groups. The mean change in the number of regular medicines was -1.4 [standard deviation (SD), 2.3] in the intervention group and +0.2 (SD, 1.8) in the control group (p<0.001). The mean change in the number of PIMs was -0.5 (SD, 0.9) in the intervention group and +0.1 (SD, 0.8) in the control group (p<0.001). In-hospital adverse events other than falls and delirium were significantly less common in the deprescribing intervention group than in the control group. Conclusion Deprescribing intervention by our multidisciplinary team seems to have been effective in reducing the number of prescribed medicines and PIMs in elderly orthopedic inpatients, with some accompanying reduction in certain adverse events.

Home Hospital for Orthopaedic Surgery: Opportunities and Challenges of a New Delivery Model.

Home Hospital (HH) is a clinical service involving the delivery of acute inpatient care in the home setting. Acute care services provided via HH include continuous telemonitoring, intravenous fluids and medications, nursing care, point-of-care imaging and laboratory tests, and in-person and virtual clinician visits. Despite offering an inpatient level of care, HH has lower fixed costs and less overhead than conventional hospital settings and offers rapid scalability. Originally implemented for acute medical conditions, HH has proven to be a safe and value-based care-delivery model for a variety of medical conditions, ranging from heart failure to chronic obstructive pulmonary disease exacerbations. For surgical conditions, HH represents an opportunity to reduce adverse hospital-acquired conditions, improve patient and caregiver satisfaction, and decrease cost. The patient profile of orthopaedic surgery inpatients matches that of patients who are most likely to benefit from HH-namely, those who are prone to functional decline, delirium, and nosocomial infections. A focus on surgeon leadership, quality and safety, and digital health with collection of patient-reported outcome measures (PROMs) will ensure that the potential of HH is realized as implementation and widespread rollout proceed.

257 The Effect of the COVID-19 Pandemic on Mental Health Associated Trauma, Admissions and Fractures at a London Major Trauma Centre

Abstract Aim Non-injury related factors have been extensively studied in major trauma and shown to have a significant impact on patient outcomes, with mental illness and associated medication use proven to have a negative effect on bone health and fracture healing. We report the epidemiological effect of COVID-19 pandemic on mental health associated Orthopaedic trauma, fractures, and admissions to our centre. Method We collated data retrospectively from the electronic records of Orthopaedic inpatients in an 8-week non-COVID and COVID period analysing demographic data, referral and admission numbers, orthopaedic injuries, surgery performed and patient co-morbidities including psychiatric history. Results here were 824 Orthopaedic referrals and 358 admissions (6/day) in the non-COVID period with 38/358 (10.6%) admissions having a psychiatric diagnosis and 30/358 (8.4%) also having a fracture. This was compared to 473 referrals and 195 admissions (3/day) in the COVID period with 73/195 (37.4%) admissions having a documented psychiatric diagnosis and 47/195 (24.1%) a fracture. 22/38 (57.9%) and 52/73 (71.2%) patients were known to mental health services, respectively. Conclusions Whilst total numbers utilising the Orthopaedic service decreased, the impact of the pandemic and lockdown disproportionately affected those with mental health problems, a group already at higher risk of poorer functional outcomes and non-union. The proportion of patients with both a fracture and a psychiatric diagnosis more than doubled and the number of patients presenting due to a traumatic suicide attempt almost tripled. It is imperative that adequate support is in place for vulnerable mental health patients, particularly as we are currently experiencing the “second wave” of COVID-19.

859 Improving Accuracy of Admission Notes Over A Four-Year Period Within an Orthopaedic Trauma Ward: A Four-Cycle Audit

Abstract Background Accurate medical notes are essential for effective patient care and safety. The Royal College of Surgeons (RCS) set forth guidelines for standards of documentation. Lack of awareness of these standards can result in inaccurate documentation, compromising patient safety. Method Four prospective audits of admission documents for orthopaedic inpatients were completed, each 1 year apart. For each cycle, 50 admission documents were assessed to determine compliance with the RCS standards. Interventions were carried out between each audit cycle in the following order: educational posters, change from handwritten to online admission forms and optimisation of the online proforma. Results Initially, only two criteria showed above 95% compliance. Implementing educational posters produced significant improvement in one criterion: ‘note signed’ (60% to 96%, p &amp;lt; 0.05). Moving admission documents online improved ‘date stamp’ (66% to 100%, P &amp;lt; 0.05) and ‘contact number’ (0% to 34%, p &amp;lt; 0.05), but decreased documentation of ‘time recorded’ (18% to 0%, p &amp;lt; 0.05) and ‘name and grade’ (74% to 26%, p &amp;lt; 0.05). Further education and modification to the admissions proforma improved documentation of all criteria to over 95%. Conclusions Early cycles of this audit highlighted poor standards of documentation in admission records. Changing to online patient records significantly changed documentation standards. These were further improved with educational measures.