Daniel Rossiter

Royal Surrey County Hospital, United Kingdom



Biography

Daniel Rossiter graduated from St George’s Hospital Medical
school in 2013 with a merit in basic sciences and a 1st class
honours degree in Anatomy from King’s college London. He
became a specialist registrar on the Kent, Surrey and Sussex
training scheme in 2017 and has spent his last two years at
the Royal Surrey County hospital, Guildford. He has an interest
in both trauma surgery and elective hip and knee orthopaedic
surgery.

Abstract

Aim: The aim of this review is to compare the delivery
of care and outcome differences between total hip
replacement (THR) performed for fractured neck of
femur and elective THR at a District General Hospital.
Methods: Retrospective analyses of 20 consecutive
patients undergoing THR for trauma were compared
with 20 consecutives elective THRs. The patients were
compared in terms of age, ASA (American Society of
Anesthesiologists) score, number of comorbidities,
length of stay from date of surgery, time to surgery, AMTS
(Abbreviated Mental Test Score), mobility, discharge
destination and the number of physiotherapy and
occupational therapy sessions undertaken.
Results: A statistically significant difference in the postoperative
length of stay was found between the groups
(elective THR v THR for Fracture, 3.9 v 5.8 days P<0.05;
median length of stay 3 v 5 days). This difference was
seen despite no statistical difference in the age, number
of comorbidities or ASA scores of both groups. Further
analysis shows that there was a significant difference in
the number of physiotherapy sessions provided between
the two groups (elective THR v THR for fracture, 1.46 v
1.24 sessions, p<0.05). In addition, differences were
also seen in the timing of initial occupational therapy
assessment.
Discussion: Patients treated with elective THRs are
not receiving the same post-operative care as those
undergoing THR for trauma in our department. The main
differences were seen in the number of physiotherapy
sessions and the timing of the occupational therapy
assessment. This is potentially contributing to an
increased length of stay in the THRs performed for
trauma.
Conclusion: We propose that the care of fractured neck
of femur patients treated with THR needs to closer follow
discharge pathways in place for elective THR.