Complications and mortality associated with olecranon fractures in the elderly: a retrospective cohort comparison from a large level one trauma centre.

Background: Olecranon fractures in the elderly have an increasing incidence. This retrospective study aims to identify the complications and survivorship of these patients. Methods: All patients >70 years old treated for an olecranon fracture at our institution were identified between 2007 and 2019. Loss of reduction and/or metalwork loosening was recorded. Also noted were wound healing problems, deep/superficial infections, and any subsequent treatment including return to surgery and/or removal of metalwork. Results: From a total of 177 cases, 28 presented with concomitant fractures (16%), half of which were hip fractures. The largest treatment group underwent tension band wiring (n = 82, 46%, mean age 80.8 yrs). Twenty-one of these suffered failure of fixation (26%), all requiring return to surgery. The second largest treatment group underwent plating (n = 50 28%, mean age 80.1 yrs). Four of these suffered failure of fixation (8%), all requiring return to surgery. Forty-four patients were treated non-operatively (25%, mean age 83.8 yrs). Two patients suffered other complications (4.5%). Overall 1 year survivorship was 0.82. Discussion: Olecranon fractures in the elderly have higher than expected 1 year mortality rates. Operative management results in high complication rates, often requiring return to surgery for metalwork problems. Significant consideration of treatment options is required in this cohort.

COVID-19 pandemic did not affect emergency theatre patient demographic and length of stay in the first phase of UK countrywide lockdown in a district general hospital.

INTRODUCTION: We aim to identify any changes in outcome for patients undergoing nonelective surgery at the start of the UK pandemic in our district general hospital. This was a single-centre retrospective cohort review of a UK district general hospital serving a population of over 250,000 people. METHODS: Participants were all patients undergoing a surgical procedure in the acute theatre list between 23 March to 11 May in both 2019 and 2020. Primary outcome was 90-day postoperative mortality. Secondary outcomes include time to surgical intervention and length of inpatient stay. RESULTS: A total of 132 patients (2020) versus 141 (2019) patients were included. Although overall 90-day postoperative mortality was higher in 2020 (9.8%) compared with 2019 (5.7%), this difference was not statistically significant (p=0.196). In 2020, eight patients tested positive for COVID-19 either as an inpatient or within 2 weeks of discharge, of whom five patients died. Time to surgical intervention was significantly faster for NCEPOD (National Confidential Enquiry into Patient Outcome and Death) code 3 patients in 2020 than in 2019 (p=0.027). There were no significant differences in mean length of inpatient stay. CONCLUSIONS: We found that patients were appropriately prioritised using NCEPOD classification, with no statistically significant differences in 90-day postoperative mortality and length of inpatient stay compared with the 2019 period. A study on a larger scale would further elucidate the profile and outcomes of patients requiring acute surgery to generate statistical significance.

Prenatal Omega-3 Supplementation and Eczema Risk among Offspring at Age 36 Months.

BACKGROUND: Long-term follow-up was completed in 84 mother-infant pairs of 118 women who completed a randomized controlled trial of prenatal supplementation with EPA- or DHA-rich fish oil or soy oil placebo. The goal of this study was to determine whether prenatal omega-3 fatty acid supplementation protects offspring against development of early childhood allergies. METHODS AND FINDINGS: Assessment of childhood allergic/atopic disease among offspring at age 36 months was performed by maternal interview using the National Health Interview Survey (NHIS) questions for childhood digestive allergies, wheezing, eczema or skin allergy, and respiratory allergy. Multiple logistic regressions examined the association between prenatal supplementation and childhood outcomes, adjusted for covariates. Eczema was reported in 26/84 (31%) of offspring at age 36 months, and was significantly more prevalent in the omega-3 supplementation groups vs. placebo: EPA 13/31 (41.9%); DHA 10/26 (38.5%); placebo 3/27 (11.1%), p=0.019. Compared to placebo, EPA and DHA were associated with ≥5 times risk of offspring eczema [odds ratios (ORs): EPA 5.8 (95% CI 1.4-23.3); DHA 5.0 (95% CI 1.2-21.0)]. After adjusting for other potential risk factors (race, birth weight, vaginal/Cesarean delivery, and maternal eczema) the magnitudes of association for omega-3 supplementation increased: EPA OR 8.1 (95% CI 1.4-45.6); DHA OR 9.6 (95% CI 1.6-58.5). Maternal eczema was also significantly associated with offspring eczema in the adjusted model: OR 10.8 (95% CI 2.1-54.3). CONCLUSION: Contrary to our hypothesis, acids supplementation compared to soy oil was associated with a substantial increase in risk of childhood eczema. This association was not observed on childhood respiratory or digestive outcomes. It is unclear if these findings were driven by unfavorable effects of omega-3s, or whether there may have been unanticipated protective effects of the soy-based placebo with regards to eczema.

Pain relief following day case laparoscopic tubal ligation with intra-peritoneal ropivacaine: a randomised double blind control study.

The aim of this study was to examine the effectiveness of ropivacaine administered by a simple intraperitoneal technique in relieving pain following laparoscopic application of Filshie clips. Nineteen patients were randomised to receive either ropivacaine (200 mg) or normal saline through the umbilical port following clip application. Using a visual analogue scale women receiving ropivacaine had significantly lower pain scores 2 hours post operatively (0.97 vs 2.03 p < 0.05). The mean total postoperative fentanyl use was also significantly lower on the ropivacaine group (40 microg vs 104 microg p < 0.02). Only 10% (1/10) of the women in the ropivacaine group complained of nausea compared with 44% (4/9) in the control group. Furthermore, 80% (8/10) of women in the ropivacaine group were either very or totally satisfied with their pain relief. Only 56% (5/9) of the women in the control group were very or totally satisfied with their pain relief. Ropivacaine administered by a simple intraperitoneal technique following laparoscopic sterilisation significantly reduces postoperative pain and parenteral analgesic requirements. It would be reasonable to consider this method as standard practice following laparoscopic tubal ligation.

Can medical students contribute to quality assurance programmes in day surgery?

CONTEXT AND OBJECTIVES: Health care delivery has undertaken a major shift from inpatient management to ambulatory surgical care with increasing emphasis on quality assurance (QA) processes. Educational opportunities for medical undergraduate programmes are being sought in the day surgery environment. Our study was undertaken to explore ways in which senior medical students can actively contribute to QA processes as part of an undergraduate day surgery educational programme. SUBJECTS AND METHODS: Health care delivery has undertaken a major shift from inpatient management to ambulatory surgical care with increasing emphasis on quality assurance (QA) processes. Educational opportunities for medical undergraduate programmes are being sought in the day surgery environment. Our study was undertaken to explore ways in which senior medical students can actively contribute to the QA processes as part of an undergraduate day surgery educational programme. SUBJECTS AND METHODS: Fifty-nine final year medical students followed allocated patients with common surgical conditions through all phases of the day surgery process. Students kept records about each case in a log book and also presented their cases at weekly Problem Based Learning tutorials. An audit of student log books and review of tutorial records was conducted for the 1996 and 1997 academic years, in order to evaluate student contribution to QA. RESULTS: Students followed 621 cases, representing a sampling of 14. 1% day surgery cases. Categories of problems highlighted by students included inappropriate patient and procedure selection, inadequate pain management, discharge, communication and resource issues. Students made a number of recommendations including the development of multilingual videotapes and patient information sheets for non-English speaking patients, avoidance of bilateral surgical procedures and improved links with local medical officers. They also developed new guidelines and protocols. CONCLUSIONS: Our study confirms that students are able to identify QA issues and propose solutions. We recommend that students have a formally recognized place in day surgery QA programmes, to close the QA loop and to adequately prepare them for medical practice in the 21st century.