ABSTRACT
PURPOSE: Standard post-operative care following sacrectomy requiring plastic surgical reconstruction limits hip flexion and avoids wound pressure. Extended bed rest adversely affects patient function, strength and range of movement. This feasibility study assessed whether early postoperative use of the tilt table was possible and promoted faster mobilisation. METHODS: Data from 10 patients were collected; five from a "standard tilt table group" and five from an "early tilt table group". Number of days post-operatively patients stood, walked, and were discharged was recorded. RESULTS: Patients had undergone partial or sub-total sacrectomy with wound closure using a variety of plastic surgical techniques. The "early tilt table" group started on the tilt table at 4.8 ± 2.8 days whereas the "standard tilt table" group started at 13 ± 5.1 days (p = 0.01*). Patients in the "early tilt table group" walked significantly earlier [10.6 ± 2.7*] than the standard group (28 ± 13) (p = 0.02*). LOS in the "early" group was 37.11 ± 11.9 days compared to 58.2 ± 21.8 days in the standard group (p = 0.10). No difference in complications between the groups. CONCLUSIONS: Early tilt table use after sacrectomy was safe and enabled a faster achievement of functional goals, thereby reducing LOS. This highlights the need for further evaluation of rehabilitation practice for this group of patients.IMPLICATIONS FOR REHABILITATIONMultidisciplinary discussion between the plastic surgeon, the tissue viability nurse and the physiotherapist about post-operative precautions and their impact on rehabilitation is essential and may enable earlier use of the tilt table.Early use of the tilt table can enable quicker mobilisation leading to the faster achievement of functional milestones and potentially a reduced length of stay (LOS) without detriment to patient outcomes/complications.The early use of the tilt table can support the central goal of surgery of enabling independence, especially as with such extensive surgery there is a big risk of institutionalisation and prolonged disability.There are potential mental health benefits to earlier mobilisation; however, this needs further investigation.
Subject(s)
Orthopedics , Plastic Surgery Procedures , Humans , Feasibility Studies , Treatment Outcome , Physical Therapy ModalitiesABSTRACT
OBJECTIVE: Transport infrastructure impacts public health. WestConnex in Sydney, New South Wales (NSW), is Australia's largest and most expensive transport infrastructure project. Concerns about the motorway project resulted in a NSW parliamentary inquiry into the project's impacts. Submissions to the inquiry were analysed to investigate their emphasis on health impacts and the cost-benefit analysis underpinning the project's business case. STUDY TYPE: Quantitative content and qualitative thematic analysis. METHODS: There were 556 submissions made to the inquiry into the impact of the WestConnex project. The content of a random sample of 93 (20%) of the individual submissions was analysed to identify health concerns. A purposive sample of 81 submissions by named groups including political parties and organisations was analysed separately (15% of the total submissions). RESULTS: Most individual submissions (63%) mentioned at least one aspect of health. Air pollution and children's health were the most frequently mentioned health issues. In the purposive sample, most submissions (64%) concerned the cost-benefit analysis (CBA), including concerns that the health impacts were being underestimated and economic benefits overestimated in the CBA. CONCLUSIONS: This study on the WestConnex project demonstrates how health impacts require early consideration within business cases for urban infrastructure projects, and later during environmental impact assessment. Systems for communicating and involving the public in decision making need to be improved, alongside greater transparency in CBA early in the project planning cycle.
