Sachin Nair1,2, Mithun Nambiar1,2, Alun Pope1, Muhajir Parkes3, Kenneth De Jong2, Raphael Hau2,4,5. 1. Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia. 2. Department of Orthopaedic Surgery, Box Hill Hospital, Melbourne, Victoria, Australia. 3. Department of Radiology, Box Hill Hospital, Melbourne, Victoria, Australia. 4. Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia. 5. Northwest Clinical School, Northern Hospital, The University of Melbourne, Melbourne, Victoria, Australia.
Abstract
BACKGROUND: Post-operative imaging aims to assess fracture reduction and fixation with better resolution than intraoperative fluoroscopy (IF). However, this routine practice may increase costs and delay the discharge of patients. The aim of this study is to assess the role of post-operative imaging in identifying patients that require a return to theatre following the use of IF. METHODS: A retrospective cohort study was conducted in a single health network comprising of two hospitals over 1 year. All fracture fixations that required IF were included. Patients who had post-operative imaging were identified and complications requiring a return to theatre were obtained. Non-trauma patients and those who did not have IF were excluded. RESULTS: A total of 1319 patients had IF. Of these patients, 1131 patients had post-operative radiographs within 7 days of their operation. In total, 12 patients (1.1%) returned to theatre as a result of a finding identified in their post-operative imaging. The calculated number of X-rays required to be taken to identify a complication was 94. The main reasons identified for these cases to require a return to theatre despite having had IF included: (i) insufficient quality/views of IF, (ii) loss of position/new injury occurring in post-operative period and (iii) poor reduction/fixation demonstrated intraoperatively that was missed/accepted. CONCLUSION: The use of post-operative radiographs can identify significant complications despite the use of IF in trauma patients. However, further consideration needs to be made regarding the benefits and costs of this practice in evaluating its clinical effectiveness.
BACKGROUND: Post-operative imaging aims to assess fracture reduction and fixation with better resolution than intraoperative fluoroscopy (IF). However, this routine practice may increase costs and delay the discharge of patients. The aim of this study is to assess the role of post-operative imaging in identifying patients that require a return to theatre following the use of IF. METHODS: A retrospective cohort study was conducted in a single health network comprising of two hospitals over 1 year. All fracture fixations that required IF were included. Patients who had post-operative imaging were identified and complications requiring a return to theatre were obtained. Non-traumapatients and those who did not have IF were excluded. RESULTS: A total of 1319 patients had IF. Of these patients, 1131 patients had post-operative radiographs within 7 days of their operation. In total, 12 patients (1.1%) returned to theatre as a result of a finding identified in their post-operative imaging. The calculated number of X-rays required to be taken to identify a complication was 94. The main reasons identified for these cases to require a return to theatre despite having had IF included: (i) insufficient quality/views of IF, (ii) loss of position/new injury occurring in post-operative period and (iii) poor reduction/fixation demonstrated intraoperatively that was missed/accepted. CONCLUSION: The use of post-operative radiographs can identify significant complications despite the use of IF in traumapatients. However, further consideration needs to be made regarding the benefits and costs of this practice in evaluating its clinical effectiveness.
Authors: Sandip Singh Saggi; Le Zhi Dexter Kuah; Lee Chuen April Toh; Mohammad Taufik Bin Mohammad Shah; Merng Koon Wong; Hamid Rahmatullah Bin Abd Razak Journal: BMJ Open Qual Date: 2022-03