Total Number Of Surgical Procedures Research Articles

Impact of COVID-19 on ophthalmic surgical procedures in sub-Saharan Africa: a multicentre study

BackgroundThe COVID-19 pandemic had a profound impact on healthcare and ophthalmology services globally. Numerous studies amongst various medical and surgical specialties showed a reduction in patient attendance and surgical procedures performed. Prior published ophthalmic literature focused on specific types of procedures and were usually single centre. The current study attempts to quantify the impact on a larger scale, namely that of sub-Saharan Africa, and to include all ophthalmic subspecialties.MethodsThis is a retrospective analysis of the surgical records from 17 ophthalmology centres in seven countries located in East, Central, West and Southern Africa. The date of declaration of the first lockdown was used as the beginning of the pandemic and the pivot point to compare theatre records one year prior to the pandemic and the first year of the pandemic. We examined the total number of surgical procedures over the two year period and categorized them according to ophthalmic subspecialty and type of procedure performed. We then compared the pre-pandemic and pandemic surgical numbers over the two year period.ResultsThere were 26,357 ophthalmic surgical procedures performed with a significant decrease in the first year of the pandemic (n = 8942) compared to the year prior to the pandemic (n = 17,415). The number of surgical procedures performed was lower in the first year of the pandemic compared to the year prior to the pandemic by 49% [Incidence rate ratio (IRR) 0.51, 95% CI 0.41–0.64), 27% (0.73, 0.55–0.99), 46% (0.54, 0.30–0.99), 40% (0.60, 0.39–0.92) and 59% (0.41, 0.29–0.57) in sub-Saharan Africa (4 regions combined), West, Central, East and Southern Africa, respectively]. The number of surgical procedures in the different sub-specialty categories in sub-Saharan Africa (4 regions combined) was significantly lower in the first year of the pandemic compared to the year prior to the pandemic, except for glaucoma (IRR 0.72, 95% CI 0.52–1.01), oncology (0.71, 0.48–1.05), trauma (0.90, 0.63–1.28) and vitreoretinal (0.67, 0.42–1.08) categories.ConclusionThis study provides insight into the impact of the COVID-19 pandemic in multiple regions and countries on the African continent. The identification of which surgical subspecialty was most affected by the COVID-19 pandemic in each region allows for better planning and resource allocation to address these backlogs.

Urology never events in the United Kingdom: A retrospective 10‐year review

AbstractObjectivesThe aim was to assess the prevalence of never events (NEs) specific to urology in the United Kingdom and identify commonly occurring themes.MethodsData from the National Health Service (NHS) NEs website were obtained and all NEs from 2012 to 2022 were reviewed. Urology‐specific NEs were identified and further analysed in their respective categories. Data regarding the total number of surgical procedures performed in the NHS specific to each specialty were obtained via the NHS Hospital Episode Statistics website.ResultsThere were 3972 NEs recorded over the 10‐year period with 95 (2.4%) of these as a result of urology surgery. The most common surgical intervention associated with a urological NE was ureteric stenting, which comprised 45/95 (47.4%) of all analysed NEs. These consisted of wrong site ureteric stent insertion (n = 29), wrong site ureteric stent removal (n = 9), wrong stent type (n = 5) and retained guidewires (n = 2). There were 7.14 million urology surgeries performed in the 10‐year period, and prevalence was 0.0013%.ConclusionNEs are fully preventable serious incidents in the NHS. This is the first study to investigate the prevalence of NEs in urology in the United Kingdom. This study demonstrates that in the last 10 years the prevalence of urology NEs is low at 0.0013%, with ureteric stent procedures accounting for more than half of the NEs. Urologists should be mindful of the potential for wrong site surgery in urologic stenting procedures.

The impact of SARS-Covid-19 pandemic on peripheral nerve surgery – A single centre report

ObjectiveSARS-Cov-19 pandemic totally changed daily routine work in German hospitals. As hospital capacity was reduced, many surgeries were postponed or even cancelled. On March 25th 2020 the German Society of Neurosurgery (DGNC) published a statement in which urgent non-elective surgeries were defined for each neurosurgical domain, whereas elective interventions were deferred. The present work examines the impact of these Covid strategies focusing on patients with peripheral lesions who were conducted to our department during this period of time. MethodsAll patients who underwent any peripheral nerve surgery at our department from January 2018 until December 2022, were included. The complete range of surgeries including peripheral nerve lesions was examined encompassing compression syndromes, traumatic lesions of brachial plexus, traumatic lesions and tumors of single peripheral nerves. The numbers of surgical procedures were compared before, during and after pandemic. Pearson correlation coefficient was analysed. ResultsFrom 2018 to 2022 the total number of surgical procedures involving peripheral nerves included 2422 procedures. Compression syndromes made up the largest proportion (1433 operations, 59%), followed by peripheral nerve lesions (445 operations, 18%), peripheral nerve tumors (344 operations, 14%) and lesions of the brachial plexus (142 operations, 6%). The average was 40,5 interventions per month, the range was 7–63. Two declines in the number of peripheral nerve surgeries were noted during this period. The first was in April and May 2020 with an average drop of 65% and 41% respectively. In these months the average number of operations was 37. The second decrease was from October 2021 until January 2022, where number of surgeries was reduced by 16%, 36%, 83% and 18% with an average number of 50 operations. Both declines showed a significant and strong correlation with the lower number of compression syndrome treatments (r = 0.952, p < 0.001 and r = 0.968, p < 0.001), while no drop and no significant correlation was found in the treatment of traumatic peripheral nerve injuries (p = 0.769, r = 0.095 and p = 0.243, r = 0.366) and traumatic brachial plexus injuries (p = 0.787, r = 0.088 and p = 0.780, r = 0.09). A weak significant correlation was seen in the treatment numbers of peripheral nerve tumors (p = 0.017, r = 0.672 and p = 0.015, r = 0.67). ConclusionCovid-19 pandemic lead to a significant decrease in the number of nerve decompressions, since, according to the German Society of Neurosurgery, those were considered as elective surgeries.

A retrospective cohort study, analyzing trends in management of upper urinary tract stones in the adult Israeli population.

To assess trends of surgical intervention in adults with upper urinary tract stones in Israel. A retrospective cohort study utilizing administrative databases held at Clalit Health Services, to identify all adults (⩾18 years) who underwent their first surgical treatment for upper tract urolithiasis. Descriptive statistics were employed to summarize baseline patient demographics and surgical trends were analyzed using the Cochrane-Armitage test for trend. Between 2003 and 2020, 36,624 adult patients were treated surgically for upper tract urinary stones. Mean age was 53.6 years (SD16.1). During the period investigated, the number of insured by Clalit Health Services increased by 25% and the total number of surgically treated stones increased by 98.7%. By type of procedure: Ureteroscopy (URS) increased by 351%, percutaneous nephrolithotripsy (PCNL) increased by 67%, shockwave lithotripsy (SWL) declined by 79%. The number of procedures per 100,000 population grew from to 37.5 in 2003 to 58.05 in 2022. The percentage increase in total number of surgical procedures was 103% and 90% in males and females, respectively. Our findings reveal significant increases in the total number of surgically treated stones over the investigated period. Notably, this increase far outpaced the growth in the number of individuals insured by Clalit Health Services. Further research and interventions are warranted to explore the underlying factors driving these trends and to develop targeted approaches for prevention, early detection, and minimally invasive treatment of upper urinary tract stones in Israel.

Simplifying Hospital Quality Comparisons for Vascular Surgery Using Center-Level Frailty Burden Rather Than Comorbidities

Failure to rescue (FtR), or inpatient death following complication, is a publicly reported hospital quality measure. Previous work has demonstrated significant variation in the proportion of frail patients across hospitals. However, frailty is not incorporated into risk-adjustment algorithms for hospital quality comparisons and risk adjustment is made by comorbidity scores. Our aim was to assess the impact of frailty on FtR quality measurement and as a means of risk adjustment. Patients undergoing open or endovascular aneurysm repair or lower extremity bypass in the Vascular Quality Initiative (VQI) at centers performing ≥ 25 vascular procedures annually (2003-2019) were included. Multivariable logistic regression evaluated in-hospital death using scaled hierarchical modeling clustering at the center level. Center FtR observed/expected ratios were compared with expected values adjusted for either standard comorbidity profiles or frailty as measured by the VQI Risk Analysis Index. Centers were divided into quartiles using VQI-linked American Hospital Association data to describe the hospital characteristics of centers whose ranks changed. A total of 63,143 patients (213 centers) were included; 1,630 patients (2.58%) were classified as FtR. After accounting for center-level variability, frailty was associated with FtR [scaled odds ratio 1.9 (1.8-2.0), P<0.001]. The comorbidity-centric and frailty-based models performed similarly in predicting FtR with C-statistics of 0.85 (0.84-0.86) and 0.82 (0.82-0.84), respectively. Overall changes in ranking based on observed/expected ratios were not statistically significant (P=0.48). High and low performing centers had similar ranking using comorbidity-centric and frailty-based methods; however, centers in the middle of the performance spectrum saw more variability in ranking alterations. Forty nine (23%) of hospitals improved their ranking by five or more positions when using frailty versus comorbidity risk adjustment. The centers in Quartile 4, those who performed the highest number of vascular procedures annually, experience on average a significant improvement in hospital ranking when frailty was used for risk adjustment, whereas centers performing the fewest number of vascular procedures and the lowest proportion of vascular surgery cases annually (Quartile 1) saw a significant worsening of ranking position (all P<0.05). However, total number of surgical procedures annually, total hospital beds, for-profit status, and teaching hospital status were not significantly associated with changes in rank. A simple frailty-adjusted model has similar predictive abilities as a comorbidity-focused model for predicting a common quality metric that influences reimbursement. In addition to distilling the risk-adjustment algorithm to a few variables, frailty can be assessed preoperatively to develop quality improvement efforts for rescuing frail patients. Centers treating a greater proportion of frail patients and those who perform higher volumes of vascular surgery benefit from a risk adjustment strategy based on frailty.

The effect of the COVID-19 pandemic on anesthesia techniques in tertiary hospital: general anesthesia or regional anesthesia - a retrospective cohort study.

We aimed to find out how the pandemic process changed the anesthesia methods applied in Çorum Single Tertiary Region Hospital. In our hospital, we investigated the anesthesia methods used for surgical procedures before and during the pandemic, the number of cases, and the impact of the pandemic on emergency and elective surgeries. This is a retrospective cohort study comparing COVID-19 pandemic's effect on the number of surgical operations and anesthesia techniques. The 22-month surgeries during the pandemic period and the 22-month pre-pandemic surgeries were compared in terms of anesthesia methods, branch-specific, and overall case changes. The data obtained were analyzed comparatively in terms of anesthetic techniques, branch-specific and overall case changes of the patients operated on in the operating room before and during the pandemic. While 65,984 surgical procedures were performed in the pre-pandemic period, only 54,352 were performed during the COVID-19 pandemic. The total number of surgical procedures decreased by 17.63% during the pandemic. While there was a 21.1% decrease in elective surgeries due to the pandemic, there was a 71.43% increase in emergency surgeries during the pandemic period. There was a significant disparity in the distribution of both elective and emergency cases by surgical specialty. It was found that the surgical specialties that received the most cases during the pandemic were General Surgery, Obstetrics-Gynecologic Surgery, Urologic Surgery and Orthopedic Surgery. During the COVID-19 pandemic, regional anesthesia (RA) was used in 16.95% of cases (as the primary technique). The use of RA as the primary anesthetic technique was significantly higher (10.61%) than in the pre-pandemic data. It was observed that specialties such as General Surgery, Obstetrics-Gynecologic Surgery, Urologic Surgery, And Orthopedic Surgery were prominent in the distribution of regional anesthesia. The COVID-19 pandemic was not the first and will not be the last and during this period we saw how important the personnel and material management are. Our study plays an important role in showing the uneven distribution of expected surgical procedures in operating rooms during the pandemic situation. It may provide guidance on the distribution of limited and essential personnel and personal protective equipment (PPE, medications, etc.) during the pandemic period. In this context, regional anesthesia may play an important role in the future because it can provide high-quality perioperative care to patients while minimizing the preference for general anesthesia during surgical procedures, thus minimizing personnel burden and limited resource use.

Intra-articular distal tibial fractures cause a major burden to individual patients and also stresses the public health care system

Background and purposeIntra-articular distal tibial fractures are most commonly caused by high-energy trauma. Additional difficulties are related to accompanying soft-tissue injuries. The purpose of this study was to evaluate the consequences of different types of distal tibial fractures to the individual patient and to the public health care system. Patients and methods126 patients with operatively treated intra-articular distal tibial fracture were identified between 2012 and 2016. Thirty-one (25%) were open fractures. Acute treatment, timing of definitive surgery, total number of surgical procedures, complications, need for soft-tissue reconstructions, hospital stay, and number of follow-up visits were recorded related to AO/OTA fracture types. Results112 patients (89%) were treated with a staged treatment protocol. Of these patients, 74 first received an external fixation device. The definitive fracture fixation was performed on average 8 days after the trauma. Soft-tissue flap reconstruction was needed in 19 patients (15%). Additionally, 7 patients required split-thickness skin grafting. Total hospital stay ranged from 2 to 87 days (median 14 days). The median ward treatment period was 12 days in B2–3 group, 13 days in C1–2 group, and 18 days in C3 group. The median of 2 (range 1–13) surgical procedures were performed. InterpretationIntra-articular distal tibial fractures cause a major burden to individual patients and stresses the public health care system due to a frequent need for several surgical procedures because of soft-tissue injuries and complications. AO/OTA type C3 fractures had the greatest burden, as patients required several consecutive operations and prolonged hospital stays.

Post-surgical emergency after-hours calls: Prevalence, concerns, and management.

The purpose of this study was to investigate the prevalence, nature, and management of post-surgical emergency after-hours calls in a dental school setting with predoctoral students, graduate students/residents, and faculty providers. A patient chart review (March 2018-February 2020) for post-surgical calls through the emergency after-hours pager system was conducted at the Marquette University School of Dentistry. The total number of surgical procedures, procedure type, the timing of call, operator experience, concern, and recommendation given during the call were documented. During the review period, 83 calls (from 75 patients) were recorded after 8,487 surgical procedures (1% of procedures). Patients called 5.4 ± 0.8 days postoperatively. Procedure type affected call prevalence (p=0.04), with most calls made after extractions (69.9% of all calls; 1% of extractions; 58/5,725), implant placement (6%; 0.9% of implant placements; 5/530) and periodontal plastic surgery (6%; 3.1% of all plastic surgeries; 5/161). The most common concern was pain (72.3%), then swelling (36.1%), bleeding (12%), and infection (9.6%). Operator experience did not affect call prevalence. Recommendations given were next business day follow-up (79.5%), reinforcement of already given postoperative instructions (51.8%), prescription (15.7%), and hospital emergency department (ED) visit (7.2%). Post-surgical emergency after-hours calls in a dental school setting occur within the first postoperative week and are rare, unrelated to operator experience, typically prompted by pain, and rarely resulting in referral to hospital ED. The use of a pager system is adequate for the management of after-hours emergencies and may reduce self-referrals to the hospital ED.

Fragmentation of practice: The adverse effect of surgeons moving around

BackgroundWhether surgical team familiarity is associated with improved postoperative outcomes remains unknown. We sought to characterize the impact of fragmented surgical practice on the likelihood that a patient would experience a textbook outcome, which is a validated patient-centric composite outcome representing an “ideal” postoperative outcome. MethodMedicare beneficiaries aged 65 and older who underwent elective inpatient abdominal aortic aneurysm repair, coronary artery bypass graft, cholecystectomy, colectomy, or lung resection were identified. Rate of fragmented practice was calculated based on the total number of surgical procedures of interest performed over the study period (2013–2017) divided by the number of different hospitals in which the surgeon operated. Surgeons were categorized into “low,” “average,” “above average,” or “high” rate of fragmented practice categories using an unsupervised machine learning technique known k-medians cluster analysis. ResultsAmong 546,422 Medicare beneficiaries who underwent an elective surgical procedure of interest (coronary artery bypass graft: n = 156,384, 28.6%; lung resection: n = 83,164, 15.2%; abdominal aortic aneurysm: n = 112,578, 20.6%; cholecystectomy: n = 42,955, 7.9%; colectomy: n = 151,341, 27.7%), median patient age was 74 years (interquartile range: 69–80), and most patients were male (n = 319,153, 58.4%). Machine learning identified 3 cutoffs to categorize rate of fragmented practice: 2.8%, 5.6%, and 10.6%. Overall, the majority of surgical procedures were performed by surgeons with a low rate of fragmented practice (n = 382,504, 70.0%); other surgical procedures were performed by surgeons with average (n = 109,141, 20.0%), above average (n = 44,249, 8.1%), or high (n = 10,528, 1.9%) rate of fragmented practice. On multivariable analyses, after controlling for patient demographics, individual surgeon volume, procedure type, and a random effect for hospital, patients who underwent a surgical procedure by a high versus low rate of fragmented practice surgeon had lower odds to achieve a postoperative textbook outcome (odds ratio 0.71, 95% confidence interval 0.77–0.84). Patients who underwent a procedure by a high rate of fragmented practice surgeon also had increased odds of a perioperative complication (odds ratio 1.30, 95% confidence interval: 1.23–1.37), extended length of stay (odds ratio 1.17, 95% confidence interval: 1.11–1.24), 90-day readmission (odds ratio 1.17, 95% confidence interval: 1.11–1.23), and 90-day mortality (odds ratio 1.29, 95% confidence interval: 1.17–1.42) (all P < .05). ConclusionPatients undergoing a surgical procedure by a surgeon with a high rate of fragmented practice had lower odds of achieving an optimal postoperative textbook outcome. Surgical team familiarity, measured by a surgeon rate of fragmented practice, may represent a modifiable mechanism to improve surgical outcomes.

Surgical Stasis: Anomalies Scarcities in Surgical Residents Training in the Covid-19 Period.

Introduction: The COVID-19 pandemic has led to a marked decrease in surgical procedures performed worldwide and to numerous other changes in medical practice. We investigated the effect of these changes on surgical trainees. Method: We searched medical records and asked a total of 67 surgical residents from different specialities (general surgery, obstetrics-gynecology, orthopedics-traumatology, neurosurgery) to answer a questionnaire investigating how the total number of surgical procedures and operative role varied for each respondent during the pandemic, the number of medical congresses and handson courses they attended during this time, how much study time was available to them and how the changes in their training modules affected them. Results: Most respondents reported a marked decrease in the number of surgical procedures performed, performing key operative steps with a lower frequency. Most of them believed that their training stagnated or suffered a setback. However, most residents consider the changes in their training during the pandemic a useful experience. Conclusion: The real effect of the COVID-19 pandemic on surgical training should be further studied. Future prospective studies should identify threshold values for each surgical procedure and the most effective compensatory strategies.

Trends in Surgical Treatment of Femoral Head Osteonecrosis in South Korea: An Analysis Using Nationwide Claims Database.

Osteonecrosis of the femoral head (ONFH) involves young or middle-aged adults, and its incidence is increasing along with increasing use of steroids in the management of organ transplantation and adjuvant therapy for malignant neoplasms. To date, no pharmacological agent has been proven to prevent or retard the progression of ONFH, and surgical procedures including joint preservation procedures and hip arthroplasties are main treatments for the disease. Although ONFH is the most common or second most common disease for hip arthroplasty in East Asian countries, the trend of surgical procedures in this region remains unknown. Thus, we evaluated trends in surgical treatment of the disease in South Korea. We identified patients with ONFH from the Korean Health Insurance Review and Assessment (HIRA) database, a nationwide medical claims database of South Korea, between January 2007 and December 2018 and calculated the proportions of following surgical procedures at each year: total hip arthroplasty (THA), hemiarthroplasty (HA), core decompression/multiple drilling, femoral osteotomy, and vascularized bone grafting. The total number of procedures increased from 3,824 in 2007 to 6,929 in 2018. Overall, the rate of THA (86%) was far greater than other procedures. From 2007 to 2018, the percentage of THA among the procedures increased from 80% to 91%, while that of joint preservation procedures decreased from 11% to 5%. The total number of surgical procedures performed for ONFH increased and the percentage of THA increased, while that of joint preservation procedures decreased from 2007 to 2018 in South Korea.

Surgical activity in England and Wales during the COVID-19 pandemic: a nationwide observational cohort study

BackgroundA significant proportion of healthcare resource has been diverted to the care of those with COVID-19. This study reports the volume of surgical activity and the number of cancelled surgical procedures during the COVID-19 pandemic. MethodsWe used hospital episode statistics for all adult patients undergoing surgery between January 1, 2020 and December 31, 2020 in England and Wales. We identified surgical procedures using a previously published list of procedure codes. Procedures were stratified by urgency of surgery as defined by NHS England. We calculated the deficit of surgical activity by comparing the expected number of procedures from 2016 to 2019 with the actual number of procedures in 2020. Using a linear regression model, we calculated the expected cumulative number of cancelled procedures by December 31, 2021. ResultsThe total number of surgical procedures carried out in England and Wales in 2020 was 3 102 674 compared with the predicted number of 4 671 338 (95% confidence interval [CI]: 4 218 740–5 123 932). This represents a 33.6% reduction in the national volume of surgical activity. There were 763 730 emergency surgical procedures (13.4% reduction) compared with 2 338 944 elective surgical procedures (38.6% reduction). The cumulative number of cancelled or postponed procedures was 1 568 664 (95% CI: 1 116 066–2 021 258). We estimate that this will increase to 2 358 420 (95% CI: 1 667 587–3 100 808) up to December 31, 2021. ConclusionsThe volume of surgical activity in England and Wales was reduced by 33.6% in 2020, resulting in more than 1.5 million cancelled operations. This deficit will continue to grow in 2021.

Effects of radiation on toxicity, complications, revision surgery and aesthetic outcomes in breast reconstruction: An argument about timing and techniques

Radiotherapy (RT) combined with breast reconstruction can reduce the risk of cancer recurrence and increase the survival rate. However, this approach seems to worsen aesthetic outcomes and increase complication rates. The impact of breast reconstruction timing and techniques on clinical outcomes, however, remains unclear. For this reason, we aimed to perform a more comprehensive analysis of a series of patients undergoing RT and breast reconstruction. Patients were divided into 4 groups according to the timing of reconstruction (before RT and after RT) and surgical technique (heterologous reconstruction and autologous reconstruction (AR)). The median time between RT and reconstruction, number of revision surgeries, incidence of complications, toxicity, aesthetics and associated clinical risk factors were used to assess the clinical outcomes. An objective system of skin toxicity evaluation was performed. Ninety-five patients were included in this study. No significant differences in the median time between RT and reconstruction, incidence of complications, toxicity or aesthetics were noted between different timings or techniques of reconstruction. Patients undergoing AR needed more revision surgeries to complete reconstruction. However, the total number of surgical procedures was similar between the groups. In a comparison between the treated and untreated breasts by an objective system, RT produced an increase in erythema and pigmentation and a decrease in elasticity in the treated breast (p<0.05 for all parameters). On multivariate analysis, smoking was a significant predictor associated with complications. Combined breast reconstruction and RT seem to be successful regardless of the order of treatment or the type of reconstruction.

The Feasibility and Safety of Routine Thoracic Surgeries in the Low-Risk Areas During the Coronavirus Disease 2019 Pandemic

Coronavirus disease 2019 (COVID-19) has been under good control, and work resumption has been gradually carried out in most parts of the People’s Republic of China including Shanghai after March 2020. However, intense focus and resources have been diverted to patients with COVID-19, leaving patients with diseases other than COVID-19 somehow neglected owing to limited access to routine health care. Furthermore, whether routine thoracic surgery service is safe in low-risk areas of COVID-19 infection is still unknown. We hereby retrospectively analyzed the quantity and quality of thoracic surgeries performed by a single team from the Shanghai Chest Hospital between January and May 2020, compared with the corresponding period in the past year. Results suggested that comparable qualities of diagnosis, surgical treatment, and perioperative outcomes were safely and successfully achieved. The total number of surgical procedures gradually increased and surpassed with that of the corresponding period in the past year when the situation of COVID-19 has been in good control in Shanghai by April. Importantly, neither medical staffs nor patients were diagnosed of having COVID-19 infection. In conclusion, although COVID-19 has made considerable impact on elective surgery for thoracic diseases, it is safe and feasible to carry out routine thoracic surgery services in low-risk areas, provided that careful screening of COVID-19 and thorough protection of medical staffs and patients are taken. It is hoped that these findings would serve as a useful reference for thoracic departments all over the world during the COVID-19 pandemic, especially after work resumption.

Stress urinary incontinence in the mesh complication era: current Australian trends.

To examine available data relating to the surgical management of stress urinary incontinence (SUI) in Australia before, during and after a well-publicized Senate Inquiry into transvaginal mesh use and to consider outcomes in the context of global guideline changes. The annual number of surgical procedures for the management of SUI by procedure type and age group for the years 2008/2009-2017/2018 was obtained from the Australian Government Department of Human Services database using Medicare Benefits Schedule item numbers. The data extracted were limited to women aged 25years and older. These data were used to calculate age-specific and age-standardized rates, so as to accurately analyse trends in the usage of different procedures. Hospital Episode Statistics for mid-urethral sling (MUS) insertions were obtained for England's National Health Service from the Health and Social Care Information Centre for the years 2008/2009-2016/2017. These data were also used to calculate annual age-standardized rates for comparison purposes. Rates declined for most SUI procedures over time (MUS, colposuspension, fascial slings) except for urethral bulking agents. The absolute number of MUSs implanted in 2008/2009 was 5729, which decreased to 3127 in the 2017/2018 financial year. Over the decade, the annual rate for MUS implantation per 100000 population halved from 78 to 36. Over this same period, the rate of usage of bulking agents doubled, although represented a low volume of procedures (overall numbers increased from 304 to 698, representing an increase from four to eight procedures per 100000 population). The age-specific peak rate for MUS and Burch colposuspension changed over the decade from 55-64years to 65-74years, suggesting that women are deferring surgical treatment until later in life. Over the last decade, the total number of surgical procedures performed in Australia to treat SUI has decreased markedly from 6812 to 4279. This represents a decrease in the annual rate per 100000 population from 93 to 49. There are clear changes evident for SUI management in the past decade in Australia, including an overall decline in operative numbers, which correlate with international advisory notifications and local investigations. The results of the Australian Senate inquiry, including removal of single-incision mini-slings, greater availability of patient resources, and greater regulation of SUI procedures, will probably have ongoing effects. Surgeons need to ensure that sufficient training and patient education continue in order to maintain appropriate access to treatment of SUI in the future.

OP0200 PATIENTS WITH HYPERMOBILITY RELATED DISORDERS HAVE A SIGNIFICANT NUMBER OF ORTHOPAEDIC INTERVENTIONS ON MULTIPLE SITES AND AT A YOUNG AGE: DATA FROM A TERTIARY REFERRAL CENTRE

Background:Mechanisms of pain associated with joint hypermobility are poorly understood and include nociceptive pain from structural joint changes along with soft tissue injuries linked to impaired proprioception; central sensitisation associated with chronic pain and muscle weakness alongside deconditioning. Anxiety and depression are also thought to play a role in patients presenting with pain and hypermobility. We have observed an increase in the rate of orthopaedic surgical procedures undertaken in patients attending the hypermobility clinics compared to those attending the general rheumatology and chronic pain clinics. There is limited published data regarding orthopaedic interventions in patients with hypermobility related disorders especially those with confirmed genetic mutations.Objectives:We aimed to evaluate the characteristics of patients in our hypermobility cohort focusing on those who had received prior surgical intervention in order to understand the underlying mechanism behind their presentations.Methods:A retrospective review of medical records was conducted of patients attending a hypermobility clinic at our tertiary referral centre, University College London Hospital, between January 2018 and December 2018.Results:There were 350 patients (300 females, 50 males) with a mean age of 36 years (range 18-71 years). 63% had a diagnosis of Hypermobility Spectrum Disorder or Hypermobility Syndrome and 37% had a type of Ehlers-Danlos Syndromes (EDS) (hypermobile, classical, vascular or other rare type). 46 patients (13%) had documented genetic mutations. 83 patients (24%) had undergone orthopaedic interventions including 9 who had EDS with confirmed genetic mutations. 54% of patients who had surgical intervention were under the age of 40. The total number of surgical procedures in the cohort was 227 (equating to 0.6485 interventions per patient). Of those requiring operative intervention, the average number of interventions per patient was 2.73. One third of patients had surgery on two or more joint groups, including 8 patients (2%) who had surgery in four or more joint groups. Knees (24%) and hips (23%) were the most common sites for operative intervention with 9% having surgery on their shoulders. 29% of pts had significant hypermobility with a Beighton score of 7 and above but there was no correlation between Beighton score and number of surgical procedures. Only 2% of cases were referred from an orthopaedic team thereby excluding a referral bias.Conclusion:Patients with hypermobility related disorders have a significant number of orthopaedic surgical procedures on multiple sites and at a young age, with indication of mechanical pathology playing an important role in their symptoms. The Beighton score does not appear to be a reliable predictor of surgical intervention. This is not surprising given that the score only covers 5 joint areas and excludes common surgical sites such as the hips and shoulders. Early diagnosis and a holistic non-operative approach combining physiotherapy and chronic pain management is essential to reduce the need for multiple surgical procedures.

P118 Orthopaedic surgical interventions in a cohort of patients with hypermobility related disorders, compared with chronic pain syndrome patients in a tertiary referral centre

Abstract Background Mechanisms of pain associated with hypermobility are poorly understood and include nociceptive pain due to structural joint changes, neuropathic pain due to disrupted proprioception, muscle weakness and central sensitisation. The influence of anxiety and low mood is also unknown. There is limited published evidence regarding orthopaedic interventions in hypermobile patients particularly following the updated 2017 Ehlers-Danlos syndrome (EDS) classification criteria. We aimed to evaluate the characteristics of a hypermobility patient cohort who had received surgical interventions and compare these with a patient population with chronic pain syndromes. Methods A retrospective analysis of medical records was conducted of patients attending a tertiary referral centre (University College London Hospital) between January 2018 and December 2018. A hypermobility-related disorders cohort was compared with a cohort of patients with chronic pain syndrome, including fibromyalgia (but without any evidence of hypermobility). Results There were 350 patients (300 females, 50 males) in the hypermobility cohort with a mean age of 36 years (range 18-71 years) at time of clinic review. 63% had hypermobility spectrum disorder or hypermobility syndrome and 37% had EDS (hypermobile, classic, vascular and other rare types). 24% of hypermobile patients had undergone orthopaedic interventions. The Beighton score did not correlate with surgical procedures. 134 patients (121 females, 13 males) with chronic pain syndromes were identified, with a mean age of 51 years (range 26-85 years). 16% of chronic pain patients had received orthopaedic surgery. 76% of hypermobile patients who had orthopaedic interventions were under 50 years old, compared to 23% in the chronic pain cohort. The total number of surgical procedures in the hypermobility cohort was 227 (0.6485 interventions per patient) compared with 25 in the chronic pain cohort (0.1865 interventions per patient); relative risk 3.477 (95% CI 2.42-4.99; P &amp;lt; 0.0001, chi-squared test). 33% of hypermobile patients had surgery on two or more joint groups (including 8 patients who had surgery in four or more joint groups), whereas 95% of chronic patients had surgery on only one joint group. In the hypermobile group the knee (23%) and hips (24%) were the most common site of operative intervention; however in the chronic pain cohort the most common sites were the knee (32%), spine (20%) and shoulders (20%), with only 4% requiring hip surgery. Conclusion Patients with hypermobility have a greater number of surgical procedures at multiple joint sites and at a younger age than patients with chronic pain syndromes, suggesting that mechanical pathology (rather than pain alone) and anticipated surgical success may contribute to the need for surgical intervention. The Beighton score does not appear to be a reliable predictor of surgical intervention. Earlier diagnosis and a holistic, non-operative approach, including physiotherapy and pain management, may reduce the need for surgical procedures. Disclosures S. Wright None. P. Mehta None. A. Rahman None. H. Kazkaz None.

CERVICAL MYELOPATHY AS THE MOST COMMON SYMPTOMS IN PATIENTS UNDERGOING C-SPINE SURGERY IN THE SPINE DIVISION, DEPARTMENT OF NEUROSURGERY, CIPTO MANGUNKUSUMO GENERAL HOSPITAL, FROM JANUARY 2012 TO DECEMBER 2016

Background. Cervical spine disease has the potential to reduce productivity in affected patients because of myelopathy and mood disorder (e.g. depression) which lead to decreasing of the patient’s quality of life. Objective. This study aims to elaborate the most frequent symptoms and pathology of C-spine disease in patients who underwent a surgical procedure over the period time from January 2012 to December 2016. Method. This study is a retrospective, conducted in Spine Division of Department of Neurosurgery, Faculty of Medicine, Universitas Indonesia (FMUI). All patients who underwent surgery for the C-spine disease are included. The data was obtained from the records in our spine database. Result. The total number of surgical procedures for spine disease over the 5 years was 345 procedures, with 127 procedures in the C-spine which are the second most common procedures of spine surgery in Department of Neurosurgery FMUI. The C-spine diseases were more common in males, aged more than 50 years old. The most frequent disease or pathology is degenerative disease, and yet, tumour cases show an increasing number and became the most common pathology in the year of 2016. The most common procedure is anterior cervical discectomy and fusion (ACDF).Conclusion. Our study showed that the most common symptoms and pathology are myelopathies and degenerative disease respectively, which has similarity with another study in the term of the most frequent pathology and surgical procedure. The finding of the more advanced neurological condition by the time of surgery as the most common symptom is found to be contradictory with other studies in western countries.

A retrospective study of ketamine administration and the development of acute or post-traumatic stress disorder in 274 war-wounded soldiers.

The objective of this study was to explore whether ketamine prevents or exacerbates acute or post-traumatic stress disorders in military trauma patients. We conducted a retrospective study of a database from the French Military Health Service, including all soldiers surviving a war injury in Afghanistan (2010-2012). The diagnosis of post-traumatic stress disorder was made by a psychiatrist and patients were analysed according to the presence or absence of this condition. Analysis included the following covariables: age; sex; acute stress disorder; blast injury; associated fatality; brain injury; traumatic amputation; Glasgow coma scale; injury severity score; administered drugs; number of surgical procedures; physical, neurosensory or aesthetic sequelae; and the development chronic pain. Covariables related to post-traumatic and acute stress disorders with a p≤0.10 were included in a multivariable logistic regression model. The data from 450 soldiers were identified; 399 survived, of which 274 were analysed. Among these, 98 (36%) suffered from post-traumatic stress disorder and 89 (32%) had received ketamine. Fifty-four patients (55%) in the post-traumatic stress disorder group received ketamine vs. 35 (20%) in the no PTSD group (p<0.001). The 89 injured soldiers who received ketamine had a median (IQR [range]) injury severity score of 5 (3-13 [1-26]) vs. 3 (2-4 [1-6] in the 185 patients who did not (p<0.001). At multivariable analysis, only acute stress disorder and total number of surgical procedures were independently associated with the development of post-traumatic stress disorder. In this retrospective study, ketamine administration was not a risk factor for the development of post-traumatic stress disorder in the military trauma setting.

A Nationwide Study of Multiple Endocrine Neoplasia Type 2A in Norway: Predictive and Prognostic Factors for the Clinical Course of Medullary Thyroid Carcinoma.

Multiple endocrine neoplasia type 2A (MEN 2A) is an autosomal dominant syndrome caused by activating germline mutations in the RET (REarranged during Transfection) proto-oncogene. MEN 2A has a strong (>95%) and age-dependent (5-25 years) clinical penetrance of medullary thyroid carcinoma (MTC). Several major studies have analyzed the predictive and prognostic factors for MEN 2A to find indicators that predict the optimal timing of prophylactic thyroidectomy. The aims of this study were to describe all known RET positive MEN 2A patients diagnosed in Norway and to evaluate the clinical course of MTC, as well as its predictive and prognostic factors. This nationwide retrospective cohort study included data for 65 (14 index and 51 screening patients) out of a total of 67 MEN 2A patients with the RET gene mutation who were diagnosed in Norway since 1974. Data were collected by reviewing patient files. The variables analyzed were genotype, phenotype, preoperative basal calcitonin, age at thyroid surgery, central lymph node dissection and nodal status at primary surgery, number of surgical procedures, and biochemical cure. Of the 65 patients, 60 had undergone thyroid surgery. The median follow-up period was 9.9 years. The patients were divided into pre-RET-and RET-era, which included patients who had thyroid surgery before January 1, 1994, and after, respectively. In index and screening patients, MTC was found, respectively, in 100% and 45% of cases, central lymph node dissection at primary surgery was done for 64% and 52% of patients, and the median total number of surgical procedures was two (range 1-6) and one (range 1-4). At primary surgery, all patients (n = 13) with lymph node metastases had preoperative basal calcitonin levels ≥68 pg/mL, and all patients (n = 17) without central lymph node dissection and preoperative basal calcitonin <40 pg/mL were biochemically cured. Multivariate analysis showed that preoperative basal calcitonin was a significant predictive factor for MTC superior to age at thyroid surgery when analyzing the entire period (p = 0.009) and the RET-era separately (p = 0.021). Prognostic factors for biochemical cure were preoperative basal calcitonin, central lymph node dissection, and nodal status at primary surgery (p = 0.037, p = 0.002, and p = 0.005) when analyzing the entire period, but only nodal status at primary surgery when the RET-era was considered separately (p = 0.006). Preoperative basal calcitonin alone can serve as an indicator for optimal timing and the extent of thyroid surgery for MEN 2A patients that could be considered safe. The results are consistent with previously reported data.