[Forced centralized allocation in the emergency department-what has the COVID-19 pandemic changed?] / Akutbelegungen in der Notaufnahme ­ was hat die COVID-19-Pandemie verändert?

BACKGROUND: IVENA eHealth (IVENA, interdisziplinärer Versorgungsnachweis, mainis IT-Service GmbH, Offenbach am Main, Germany) supports the coordination of emergency admissions by providing real-time data on treatment options in hospitals. Overload or technical problems can lead to hospitals having to temporarily deregister parts or the entire emergency department, which can lead to acute admissions. The COVID-19 pandemic may have further exacerbated the situation, which was analyzed as part of this study. METHODS: This descriptive analysis used the IVENA eHealth information technology (IT) system to examine the occupancy and acute occupancy figures in the Munich ambulance service area from 2016-2022. Particular attention was paid to inpatient (SC II) and shock room + admissions in the specialties of internal medicine, neurology, trauma surgery and urology, as well as the development of acute occupancies, especially after the COVID-19 pandemic. RESULTS: During the COVID-19 pandemic in 2020, the number of patients in the surveyed specialist areas fell by 23.7% (2021: -15% and 2022: -11% compared to 2019). The proportion of acute admissions fell in 2020 compared to 2019 (5.9% acute admissions vs. 6.8%) and rose disproportionately in 2021 (7.7% vs. 6.8%) and 2022 (24.9% vs. 6.8%). CONCLUSION: There are many reasons for the increase in acute admissions, including the increase in inpatient admissions, the bottleneck in transferring patients (exit block) and the shortage of staff in the healthcare system. The COVID-19 pandemic has exacerbated some of these problems, which could explain the increase in acute admissions. A combination of different solutions is now needed to ensure adequate emergency care.

Open-wedge high tibial osteotomy with and without bone void filler: Allograft leads to faster bone union and weight bearing with comparable return to work and sports rates.

PURPOSE: To compare the clinical and radiological outcome of open-wedge high tibial osteotomy (OWHTO) with allogenous bone chips to a control group without bone void filler. The focus was on the rates and timelines of return to work (RTW) and return to sports (RTS), given the significance of these factors for the satisfaction of young and active patients. METHODS: One hundred and ninety-five cases of OWHTO (112 cases with allograft vs. 83 cases without graft) with a follow-up of 17 ± 4.8 months were included in this retrospective analysis. Various metrics were investigated, including time to return to full weight bearing, RTW and RTS rates and timelines, International Knee Documentation Committee (IKDC) Score, Cincinnati-Sportsmedicine and Orthopaedic Centre Score and Tegner Score. The time to bone union was determined on radiographs taken at 6, 16, 28 and 53 weeks. RESULTS: Patients returned to full weight bearing after 8.8 ± 4.8 weeks. RTW was possible for 92.8% after 13.7 ± 12.3 weeks. 96.2% returned to sports after 22.7 ± 8.3 weeks, but the number of disciplines and workouts per week diminished (p < 0.001, p = 0.006). A shift to low-impact and recreational sports was observed. Patients with allograft filling had earlier bone union (21 ± 12.3 vs. 31.9 ± 14.2 weeks, p < 0.001) and returned faster to full weight bearing (8.2 ± 4.5 vs. 9.8 ± 5 weeks, p = 0.013). There was no difference between groups in the IKDC Score (69 ± 17.2 vs. 69.9 ± 15.2, p = 0.834), Cincinnati-Sportsmedicine and Orthopaedic Centre Score (68 ± 18.3 vs. 69.4 ± 18.2, p = 0.698) and Tegner Score (3.8 ± 1.5 vs. 4 ± 1.5, p = 0.246). CONCLUSION: Allograft filling leads to faster bone union and return to full weight bearing but showed no significant advantage in terms of RTW/RTS, overall patient satisfaction and functional scores. The decision for or against filling the osteotomy gap, therefore, remains a case-by-case decision. LEVEL OF EVIDENCE: Level III, Retrospective cohort study.

The role of extended coagulation screening in adult cranial neurosurgery.

Introduction: Postoperative hemorrhage after adult cranial neurosurgery is a serious complication with substantial morbidity and mortality. Research question: We investigated if an extended preoperative screening and an early treatment of previously undetected coagulopathies may decrease the risk of postoperative hemorrhage. Methods: A prospective study cohort of patients undergoing elective cranial surgery and receiving the extended coagulatory work-up were compared to a propensity matched historical control cohort. The extended work-up included a standardized questionnaire on the patient's bleeding history as well as coagulatory tests of Factor XIII, von-Willebrand-Factor and PFA-100®. Deficiencies were substituted perioperatively. The primary outcome was determined as the surgical revision rate due to postoperative hemorrhage. Results: The study cohort and the control cohort included 197 cases each, without any significant difference in the preoperative intake of anticoagulant medication (p â€‹= â€‹.546). Most common interventions were resections of malignant tumors (41%), benign tumors (27%) and neurovascular surgeries (9%) in both cohorts. Imaging revealed postoperative hemorrhage in 7 cases (3.6%) in the study cohort and 18 cases (9.1%) in the control cohort (p â€‹= â€‹.023). Of these, revision surgeries were significantly more common in the control cohort with 14 cases (9.1%) compared to 5 cases (2.5%) in the study cohort (p â€‹= â€‹.034). Differences in mean intraoperative blood loss were not significant with 528 â€‹ml in the study cohort and 486 â€‹ml in the control cohort (p â€‹= â€‹.376). Conclusion: Preoperative extended coagulatory screening may allow for revealing previously undiagnosed coagulopathies with subsequent preoperative substitution and thereby reduction of risk for postoperative hemorrhage in adult cranial neurosurgery.