Background At Queen Elizabeth Hospital Birmingham (QEHB), no specific protocol to stratify patients by body mass index (BMI) exists. This study sought to evaluate outcomes following gastrointestinal surgery. Methods Patients undergoing gastrointestinal surgery attending preassessment screening clinic (PAS) from August to September 2016 at the QEHB were identified. Primary outcome was postoperative complications. Secondary outcomes were major complications and 30-day readmission rates. Results Of 368 patients preassessed, 31% (116/368) were overweight and 35% (130/368) were obese. Median age was 57 (range: 17–93). There was no difference of BMI between the low risk and high risk clinics. Patients in high risk clinic had significantly higher rates of comorbidities, major surgical grades, and malignancy as the indication for surgery. Overall complication rates were 14% (52/368), with 3% (10/368) having major complications (Clavien-Dindo Grades III-IV). Whilst BMI was associated with comorbidity (p = 0.03) and ASA grade (p < 0.001), it was not associated with worse outcomes. Patients attending high risk clinic had significantly higher rates of complications. Conclusions Surgery grade was found to be an independent risk factor of complication rates. Use of BMI as an independent factor for preassessment level is not justified from our cohort.

Highlights Implant failure is the most common reason for revision of growing prostheses. Maximum prosthesis growth with a residual LLD is the most common mode of failure. Functional outcomes are good, but 1/ 5 patients have a persistent LLD over 2 cm.

Background Preoperative risk stratification and optimising care of patients undergoing elective surgery are important to reduce the risk of postoperative outcomes. Renal dysfunction is becoming increasingly prevalent, but its impact on patients undergoing elective gastrointestinal surgery is unknown although much evidence is available for cardiac surgery. This study aimed to investigate the impact of preoperative estimated glomerular filtration rate (eGFR) and postoperative outcomes in patients undergoing elective gastrointestinal surgeries. Methods This prospective study included consecutive adult patients undergoing elective gastrointestinal surgeries attending preassessment screening (PAS) clinics at the Queen Elizabeth Hospital Birmingham (QEHB) between July and August 2016. Primary outcome measure was 30-day overall complication rates and secondary outcomes were grade of complications, 30-day readmission rates, and postoperative care setting. Results This study included 370 patients, of which 11% (41/370) had eGFR of <60 ml/min/1.73 m2. Patients with eGFR < 60 ml/min/1.73 m2 were more likely to have ASA grade 3/4 (p < 0.001) and >2 comorbidities (p < 0.001). Overall complication rates were 15% (54/370), with no significant difference in overall (p=0.644) and major complication rates (p=0.831) between both groups. In adjusted models, only surgery grade was predictive of overall complications. Preoperative eGFR did not impact on overall complications (HR: 0.89, 95% CI: 0.45–1.54; p=0.2). Conclusions Preoperative eGFR does not appear to impact on postoperative complications in patients undergoing elective gastrointestinal surgeries, even when stratified by surgery grade. These findings will help preassessment clinics in risk stratification and optimisation of perioperative care of patients.

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Aim The primary aim of this study was to evaluate the outcomes of gastrocnemius flaps performed by appropriately trained orthopaedic surgeons for soft-tissue coverage in the context of periprosthetic joint infection (PJI) and, secondly, to evaluate the infection-free survival of this patient group. Method We retrospectively reviewed 30 patients who underwent gastrocnemius flap reconstruction during staged revision total knee arthroplasty for prosthetic joint infection (PJI). All flaps were performed by an orthopaedic surgeon with orthoplastics training. Patients had a mean age of 68.9 years (range 50–84) and were followed up for a mean of 50.4 months (range 2–128 months). A total of 29 patients (97%) were categorized into Musculoskeletal Infection Society (MSIS) local extremity grade 3 (greater than two compromising factors), and 52% of PJIs were polymicrobial. Results Flap survival was 100% with no failures or early returns to theatre for flap problems such as necrosis or haematoma. Overall infection-free survival during the study period was 48% (13 of 27 infected cases). Infection recurrence occurred in 48% (10 patients) in the type B3 cohort and 67% (4 patients) in the type C3 cohort (p = 0.65). Conclusions The surgical technique for a gastrocnemius myofascial flap is reliable and reproducible when performed by appropriately trained orthopaedic surgeons, even in high-risk groups. However, the risks of recurrent infection and amputation remain high within our series due to poor host and extremity factors.