Closing the health gap in Central Australia: reduction in Indigenous Australian inpatient self-discharge rates following routine collaboration with Aboriginal Health Workers.

BACKGROUND: Indigenous Australians experience significant socioeconomic disadvantage and healthcare disparity compared to non-Indigenous Australians. A retrospective cohort study to describe the association between rates of self-discharge in Indigenous orthopaedic patients and the introduction of routine Aboriginal Liaison Officers (ALO) within the Orthopaedic multi-disciplinary team (MDT) was performed. METHODS: ALO were introduced within our routine Orthopaedic MDT on the 22nd of February 2021. Two patient cohorts were analysed, Group 1; patients admitted in the 9-months prior to inclusion of ALO, and Group 2; patients admitted within 9-months thereafter. The primary outcome of interest was the rate of self-discharge among Indigenous patients. Secondary outcomes of interest were the stage of treatment when patients self-discharged, recurrent self-discharge, risk factors for self-discharge and association between self-discharge and length of hospital stay. RESULTS: Introduction of ALO within routine Orthopaedic MDT was associated with a significant 37% reduced risk of self-discharge among Indigenous patients (p = 0·009), and significantly fewer self-discharges before their definitive surgical and medical treatment (p = 0·0024), or before completion of postoperative intravenous antibiotic treatment (p = 0·030). There was no significant change in the risk of recurrent self-discharge (p = 0·557). Risk factors for self-discharge were younger age; pensioners or unemployed; residents of Alice Springs Town-Camps or of communities within 51 to 100 km of Alice Springs; and those diagnosed with lacerations of the upper limb, but without tendon injury, wound and soft tissue infections or osteomyelitis. In Group 2, the odds of self-discharge decreased with increased length of hospital stay (p = 0·040). CONCLUSIONS: Routine inclusion of ALO within the Orthopaedic MDT reduced the risk of self-discharge in Indigenous patients. Those who self-discharged did so only after critical aspects of their care were met.

Open or Arthroscopic Synovectomy Is the Preferred Management Option in Pigmented Villonodular Synovitis of the Hip Joint Without Evidence of Degeneration: A Systematic Review of 20 Studies.

Purpose: To provide an up-to-date systematic review on the treatment options for pigmented villonodular synovitis (PVNS) of the hip and provide a grade of recommendation using standardized systems. Methods: A systematic search of PubMed, Embase, Web of Science, and The Cochrane Library from the date of inception of each database through December 4, 2021, was performed. Studies that described the outcomes of treatment of hip PVNS were identified. These outcomes were discussed and synthesized by three reviewers, and a grade of recommendation was assigned. Results: Twenty studies were identified. Seven studies described arthroscopic synovectomy, eight studies described open synovectomy, nine studies described arthroplasty, and one study described osmic acid synoviorthesis. Synovectomy, either open or arthroscopic, had similar rates of disease recurrence. Hip arthroplasty had low rates of disease recurrence compared to synovectomy; however, it was associated with significant risk of aseptic loosening in the longer term. Conclusion: Synovectomy, either open or arthroscopic based on surgeon preference, is favored in the treatment of hip PVNS if there is no evidence of joint space narrowing. Arthroplasty should be considered in cases with joint space narrowing or recurrence following joint preservation therapy. There is insufficient evidence to support synoviorthesis either as monotherapy or adjuvant therapy. Level of Evidence: IV, systematic review of Level III and IV studies.