A multi-centre, registry-based cohort study was conducted to assess the effect of the coronavirus disease 2019 (COVID-19) pandemic on the provision of non-arthroplasty hip surgery (NAHS) in the UK by (i) comparing the number of NAHS performed during the pandemic to pre-pandemic levels, (ii) prospectively auditing compliance to established guidance and (iii) evaluating post-operative outcomes and their predictors. Patients who underwent NAHS during the pandemic/pre-pandemic were selected from the Non-Arthroplasty Hip Registry, which collects demographic, procedural and pre-operative outcome data. Patients during the pandemic period were emailed separate COVID-19 surveillance questionnaires, which evaluated adherence to guidelines and post-operative outcomes. Fisher’s exact tests and logistic regression were used to identify predictors for developing COVID-19 and being re-admitted into hospital, post-surgery. There was a 64% reduction of NAHS performed during the pandemic compared to the pre-pandemic period. Ninety-nine percent of participants self-isolated, and 96.8% received screening, pre-operatively. No participant was COVID-19-positive peri-operatively. Post-operatively, participants had an intensive care unit admission rate of 2%, median hospital stay of 1 day, hospital readmission rate of 4.2%, COVID-19 development rate of 2.3% and a thromboembolic complication rate of 0.32%. No COVID-19-positive patient developed adverse post-operative outcomes. Participants who developed COVID-19 post-operatively had greater odds of having undergone osteotomy in comparison to arthroscopic surgery (P = 0.036, odds ratio = 5.36). NAHS was performed with good compliance to established guidance, and adverse operative outcomes remained low. If guidance is followed, the risk of COVID-19 post-op development is low. Although bigger operations have a slightly higher risk, this does not impact their prognosis.

IntroductionAnticholinergic medications block cholinergic transmission. The central effects of anticholinergic drugs can be particularly marked in patients with dementia. Furthermore, anticholinergics antagonise the effects of cholinesterase inhibitors, the main dementia treatment.ObjectivesThis study aimed to assess anticholinergic drug prescribing among dementia patients before and after admission to UK acute hospitals.Methods352 patients with dementia were included from 17 hospitals in the UK. All were admitted to surgical, medical or Care of the Elderly wards in 2019. Information about patients’ prescriptions were recorded on a standardised form. An evidence-based online calculator was used to calculate the anticholinergic drug burden of each patient. The correlation between two subgroups upon admission and discharge was tested with Spearman’s Rank Correlation.ResultsTable 1 shows patient demographics. On admission, 37.8% of patients had an anticholinergic burden score ≥1 and 5.68% ≥3. At discharge, 43.2% of patients had an anticholinergic burden score ≥1 and 9.1% ≥3. The increase was statistically significant (rho 0.688; p=2.2x10-16). The most common group of anticholinergic medications prescribed at discharge were psychotropics (see Figure 1). Among patients prescribed cholinesterase inhibitors, 44.9% were also taking anticholinergic medications.ConclusionsThis multicentre cross-sectional study found that people with dementia are frequently prescribed anticholinergic drugs, even if also taking cholinesterase inhibitors, and are significantly more likely to be discharged with a higher anticholinergic drug burden than on admission to hospital.Conflict of interestThis project was planned and executed by the authors on behalf of SPARC (Student Psychiatry Audit and Research Collaborative). We thank the National Student Association of Medical Research for allowing us use of the Enketo platform. Judith Harrison was su