The effect of smoking on union rates following corrective osteotomies around the knee: A systematic review and meta-analysis

BACKGROUND

Distal femur osteotomies (DFO) and high tibial osteotomies (HTO), are well-established treatment options for joint preservation in active patients with uni-compartmental osteoarthritis. Optimal outcomes are contingent on adequate preoperative evaluation of patient-specific factors. This systematic review and meta-analysis aims to explore the difference in union rates between smokers and non-smokers following corrective osteotomies around the knee.

METHODS

A systematic search of the MEDLINE and EMBASE databases was performed in accordance with the PRISMA guidelines to identify studies reporting smoking status in adults who developed delayed and/or non-union following HTO or DFO. Studies were pooled using a random effect model [Review Manager (RevMan) software, V.5.4] and heterogeneity was estimated using I2.

RESULTS

Data for meta-analysis was available for 1,406 osteotomies from 10 studies, performed in patients with mean age ranging from 38-54 years, and 65% were male. The union rate among non-smokers was 97.3% (1100/1131) compared with 89.5% (246/275) among smokers; OR 4.59 [95% CI 1.99 to 10.62], p-value < 0.001. Subgroup analysis revealed that the risk of non-union in smokers after opening wedge osteotomy was almost double (OR 4.8) that of closing wedge osteotomies (OR 2.9).

CONCLUSION

Smoking increases the risk of non-union during elective knee osteotomy surgery. Our findings also suggest that smokers have a better chance of achieving union with closing wedge osteotomy compared to open wedge osteotomy.

1245 Enhanced Recovery Program in Colorectal Surgery at Basildon And Thurrock University Hospital

Introduction

Enhanced recovery program (ERP) is an integrated multidisciplinary approach that requires participation and commitment from different member of staff, and the patient. This is an evidence-based protocol designed to standardize medical care, improve outcomes, and lower care costs. The aim of this study is to observe how ERP protocol is followed in our institution, and to monitor different outcomes. Data was compared to NICE guideline.

Method

We reviewed all patients who underwent elective colorectal resection for cancer between June 2018 and May 2019. data was collected retrospectively from patient electronic case notes. We monitored compliance with ERP protocol (NICE), as well as outcomes

Results

114 patients were included in our study. We noted that just 35% of patients had intraoperative nasogastric tube. Antibiotics: 74.56%, Catheter 98.24%, PCA 79.82%, Spinal anaesthesia 52.63%, Drain 38.59%. In the post op period, patients were mobilized at 1.89 day (1.27) [mean (SD)], NGT removal: 1.81 day (2.31) Refeeding: 1.36 day (1.01). It has been proven that patients with inadequate perioperative analgesia are more prone to develop ileus, to have a prolonged hospital stay, and have an overall higher mortality (p0.001)

Conclusions

It seems that there is a room for improvement especially in analgesia and prophylactic antibiotics. Following ERP protocols improves overall outcomes.

755 Elective Surgery in the COVID-19 Pandemic: Outcomes of 100 Consecutive Cases

Introduction

The COVID-19 pandemic halted elective surgical activity. Basildon University Hospital established an elective Green Zone for COVID-19 swab negative patients who isolated for 14 days. This study reviewed the outcomes of the first 100 patients.

Method

A single-centre study was performed. Demographic and perioperative electronic data were supplemented with telephone follow-up for the first 100 Green Zone patients and analysed in Microsoft Excel.

Results

One hundred Green Zone patients underwent surgery between 21/05/2020 and 16/06/2020. The median age was 55 (14-88) years. 52% were female. Their operations were performed by General Surgery (39%), Gynaecology (17%), Vascular Surgery (14%), Oral Surgery (12%), ENT (9%), Urology (8%), and Pain Management (1%).

Preoperatively, 100% had a negative SARS-CoV-2 swab and one had CT evidence of mild resolving COVID-19. Two patients had postoperative SARS-CoV-2 swabs, both negative. Median length of stay was 0 (0-7) days. 84% responded to telephone follow-up at a median 25 (13-54) postoperative days, 69% of whom were asymptomatic There were no 30-day major complications (>Clavien-Dindo IIIa) or 90-day mortality.

Conclusions

Elective surgery can be safe during the COVID-19 pandemic, with appropriate measures in place. This has significant implications in the context of an ever-expanding NHS waiting list during a pandemic of uncertain duration.