Cadaver dissection is the first opportunity for many students to practice handling human tissue and is their first exposure to the occupational hazards involved with this task. Few studies examine dissection room injuries to ascertain the dangers associated with dissecting. We performed a retrospective cohort analysis of dissection room injuries from four student cohorts over an eleven-year period (2001-2011), including second-year medical students, third-year medical students, second-year dental students, and third-year science students. Injury data included activity causing injury, object responsible, and injury site. A total of 163 injuries during 70,039 hours of dissection were recorded, with 66 in third-year medical students, 42 in second-year medical students, 36 in third-year science students, and 16 in second-year dental students. The overall rate was 2.87 injuries per 1,000 dissection hours, with second-year medical students most frequently injured (5.5 injuries per 1,000 hours); third-year medical students were least frequently injured (1.3 injuries per 1,000 hours). A significant difference in injury rates between student groups indicated a higher than expected injury rate to second-year medical students and lower than expected rates to third-year medical students. Injury rates increased for most groups between 2001-2006 and 2007-2011 periods. Most injuries (79%) were from scalpel cuts to the finger or thumb. This study provides injury rates for dissection room injuries to students, indicating differences in injury frequency between cohorts and an increase in injury rate over time. As scalpel cuts were the most likely injury mechanism, targeting scalpel handling with preventative strategies may reduce future injury risk.

Level II, prospective comparative study.

BackgroundThere is currently conflicting evidence surrounding the effects of obesity on postoperative outcomes. Previous studies have found obesity to be associated with adverse events, but others have found no association. The aim of this study was to determine whether increasing body mass index (BMI) is an independent risk factor for development of major postoperative complications.MethodsThis was a multicentre prospective cohort study across the UK and Republic of Ireland. Consecutive patients undergoing elective or emergency gastrointestinal surgery over a 4‐month interval (October–December 2014) were eligible for inclusion. The primary outcome was the 30‐day major complication rate (Clavien–Dindo grade III–V). BMI was grouped according to the World Health Organization classification. Multilevel logistic regression models were used to adjust for patient, operative and hospital‐level effects, creating odds ratios (ORs) and 95 per cent confidence intervals (c.i.).ResultsOf 7965 patients, 2545 (32·0 per cent) were of normal weight, 2673 (33·6 per cent) were overweight and 2747 (34·5 per cent) were obese. Overall, 4925 (61·8 per cent) underwent elective and 3038 (38·1 per cent) emergency operations. The 30‐day major complication rate was 11·4 per cent (908 of 7965). In adjusted models, a significant interaction was found between BMI and diagnosis, with an association seen between BMI and major complications for patients with malignancy (overweight: OR 1·59, 95 per cent c.i. 1·12 to 2·29, P = 0·008; obese: OR 1·91, 1·31 to 2·83, P = 0·002; compared with normal weight) but not benign disease (overweight: OR 0·89, 0·71 to 1·12, P = 0·329; obese: OR 0·84, 0·66 to 1·06, P = 0·147).ConclusionOverweight and obese patients undergoing surgery for gastrointestinal malignancy are at increased risk of major postoperative complications compared with those of normal weight.

Objectives:Managing medial compartment osteoarthritis (OA) in the younger male patient is challenging because these patients tend to be physically high demand. Traditionally, High Tibial Osteotomy (HTO) has been the favoured surgical option, but Total (TKA) and Unicompartmental (UKA) knee arthroplasty have been more recently utilized. Our aims were to compare patient reported outcome, revision and reoperation rates with these 3 procedures.Methods:Using our hospital data bases we retrieved the details of male patients under 55 who had one of the 3 procedures performed between 2005-2013, for medial compartment OA by 6 knee surgeons in our group. All 6 surgeons used the 3 procedures in this cohort. The TKA database was analysed to exclude patients who did not meet the criteria for HTO/UKA of isolated medial OA. The 3 groups had their satisfaction assessed retrospectively using the Forgotten Joint Score (FJS), information on occupation, reoperation and duration of satisfaction were also questioned. Hospital records were reviewed for the reoperation and revision rate on all of the patients identified.Results:We identified 117 TKA in patients under 55, 27 TKA which met our criteria, 75 HTO (medial opening wedge) and 95 UKA (Oxford cementless). The mean followup periods for HTO/UKA/TKA were 8.1, 6.1, 7.5 years respectively. Of the HTO group, 19 (25%) were revised to TKA at a mean 4.8 years, 8 underwent reoperation for mal/nonunion, and 10 had reoperation for fixation issues. Overall a reoperation rate of 50% and projected 10 year survivorship of 58% for HTO. Of the UKA group, there was 1 revision to TKA at 1 year for tibial component loosening and 3 reoperations for bearing instability, retaining the primary implant. Reoperation rate 4% and projected 10 year survivorship 99%. Of the TKA group there were 2 revisions at 4 years for tibial component loosening, no non-revision reoperations, reoperation rate 7.5% with projected 10 year survivorship 92.5%. The Forgotten Joint Score results (0-100) were median 21 for HTO, 38 for TKA, 67 for UKA. All comparisons between the three groups were significant. TKA vs HTO p value 0.04 (CI 0.67-36.54), UKA vs TKA p value 0.02 (CI 2.26-35.58), UKA vs HTO p value 0.00001 (CI 25.36-49.68). Further analysis of the HTO cohort revealed that 75% of the unrevised cases considered the benefit of the index procedure had expired at a mean 3.1 years, yet they had not sought further surgery, despite a mean FJS of only 18 in this subgroup.Conclusion:In this retrospective cohort study with medium term followup of 3 procedures performed by 6 knee surgeons, patients were highly matched by virtue of gender (male), age (<55 years), activity level (Tegner scores), pathology (isolated medial compartment OA). Regarding survivorship of the index procedure, the outcome for Osteotomy was poor with 58% at 10 yrs and high reoperation/complication rate of 50% at mean 4.8 years. The best survivorship/reoperation rates were in the UKA group (99% and 4% respectively). Regarding patient reported outcome using Forgott...

Background: Patient selection for critical care admission must balance patient safety with optimal resource allocation. This study aimed to determine the relationship between critical care admission, and postoperative mortality after abdominal surgery. Methods: This prespecified secondary analysis of a multicentre, prospective, observational study included consecutive patients enrolled in the DISCOVER study from UK and Republic of Ireland undergoing major gastrointestinal and liver surgery between October and December 2014. The primary outcome was 30-day mortality. Multivariate logistic regression was used to explore associations between critical care admission (planned and unplanned) and mortality, and intercentre variation in critical care admission after emergency laparotomy. Results: Of 4529 patients included, 37.8% (n¼1713) underwent planned critical care admissions from theatre. Some 3.1% (n¼86/2816) admitted to ward-level care subsequently underwent unplanned critical care admission. Overall 30-day mortality was 2.9% (n¼133/4519), and the risk-adjusted association between 30-day mortality and critical care admission was higher in unplanned [odds ratio (OR): 8.65, 95% confidence interval (CI): 3.51e19.97) than planned admissions (OR: 2.32, 95% CI: 1.43e3.85). Some 26.7% of patients (n¼1210/4529) underwent emergency laparotomies. After adjustment, 49.3% (95% CI: 46.8e51.9%, P<0.001) were predicted to have planned critical care admissions, with 7% (n¼10/145) of centres outside the 95% CI. Conclusions: After risk adjustment, no 30-day survival benefit was identified for either planned or unplanned postoperative admissions to critical care within this cohort. This likely represents appropriate admission of the highest-risk patients. Planned admissions in selected, intermediate-risk patients may present a strategy to mitigate the risk of unplanned admission. Substantial inter-centre variation exists in planned critical care admissions after emergency laparotomies.