Objectives:Post-operative retear is the most common surgical complication following rotator cuff repair with reported rates ranging from 11% to 94%. There have been a number of advancements in the technology and management of rotator cuff repair which may have improved retear rates. The aim of this study was to determine if there has been any improvements in rotator cuff repair integrity in our centre and, to identify any changes in the management of rotator cuff tears that may have impacted post-operative re tear rate.Methods:This observational single cohort study used running average analysis to examine 1600 consecutive patients who underwent primary arthroscopic rotator cuff repair by a single surgeon, and had cuff integrity assessed by ultrasound six months post operation. Exclusion criteria included revision rotator cuff repairs, isolated subscapularis repairs, and irreparable tears.Results:Retear rates over the course of our study ranged from 3% to 34%, with the mean retear rate being 15%. The retear rate at the commencement of our study was 18% and decreased to 5% by the end. Reductions in retear were associated with; more passive rehabilitation, more attention to post-operative abduction sling use, increased surgical team experience. Increases in retear rates were associated with; increased false positives with a more sensitive ultrasound machine and, learning curves with new equipment for surgeon and sonographer.Conclusion:A significant decrease in retear rate following arthroscopic rotator cuff repair was observed over the course of our study with the re-tear rate at the end of the study being 5%. While the study design does not allow us to directly attribute changes in retear rate to changes in management, our results suggest that less aggressive rehabilitation, abduction sling use and increased surgeon experience decrease postoperative retear.

Background: The gold standard of commencing hemodialysis with a functional arteriovenous fistula (AVF) is challenging. We aim to review factors associated with functional AVF at hemodialysis start at a tertiary hospital. Methods: We retrospectively reviewed incident hemodialysis patients or who had AVF creation at a single tertiary hospital from 2011 to 2016. Data was extracted for patient comorbidities, duration from referral to AVF creation and hemodialysis start, estimated glomerular filtration rate (eGFR) at surgical referral, referring nephrologist, events accelerating eGFR decline, and revisions for “failing to mature” AVF to assess factors associated with non-functioning AVF or late AVF creation, using multinomial logistic regression. Results: Two hundred two patients received hemodialysis and 51 had AVF creation but did not dialyze (AVF futility rate 20%). Of these, 133 (66%) commenced hemodialysis with a central venous catheter (CVC) and 69 (34%) with an AVF. Patients with functional AVFs at hemodialysis start were referred earlier than those with non-functional AVFs (median 256 vs 66 days before hemodialysis start, p = 0.001). Age, sex, eGFR at surgical referral, and comorbidities were not predictive of patients with functional AVFs. Events accelerating eGFR decline were associated with an increased incidence of CVC at hemodialysis start (risk ratio (RR) 4.21, 95% confidence interval (CI) 1.96–9.03, p < 0.0001). Referring nephrologists external to our renal unit may be associated with non-functional AVF at hemodialysis start (RR 6.60, 95% CI 1.74–25.13, p = 0.006). Conclusions: We found that functional AVFs required referral a median of 256 days prior to hemodialysis start and events accelerating eGFR decline increase the incidence of CVC at hemodialysis start. Age, sex, eGFR at surgical referral, and comorbidities did not inform the likelihood of timely AVF creation and evaluation of further predictive pre-dialysis factors is necessary to identify patients requiring early AVF creation whilst minimizing the cost of unnecessary procedures.

BACKGROUND AND AIMS: Diastolic dysfunction of the left ventricle is a precursor to heart failure with preserved ejection fraction (HFpEF). Detection by electrocardiography (ECG) when asymptomatic (stage B heart failure) would be valuable. We hypothesised that an explainable advanced ECG (A-ECG) score derived from standard 12-lead ECG could accurately diagnose diastolic dysfunction. METHODS: Included patients had undergone resting 12-lead ECG and echocardiography demonstrating normal systolic function, with at most mild valve disease, and either the presence (n=150) or absence (n=264) of grade II or III diastolic dysfunction. Stepwise multivariable logistic regression was used to generate an A-ECG score that was cross-validated using bootstrapping. RESULTS: A 6-measure A-ECG score was able to identify diastolic dysfunction with an area under the receiver operating characteristics curve [95% confidence interval] of 0.91 [0.88-0.94], sensitivity 83 [76-91]%, specificity 87 [77-92]%, positive predictive value 78 [69-85]%, negative predictive value 90 [86-94]%, positive likelihood ratio 6.38 [3.30-11.38] and inverse negative likelihood ratio 5.12 [3.21-10.22]. CONCLUSIONS: Standard 12-lead ECG can be used to accurately identify diastolic dysfunction by echocardiography via A-ECG. This may have clinical utility for early identification of patients who may benefit from further cardiac assessment and risk factor management to prevent progression to symptomatic heart failure.