Pain and function deteriorate in patients awaiting total joint arthroplasty that has been postponed due to the COVID-19 pandemic

BACKGROUND Elective total joint arthroplasty(TJA)procedures have been postponed as part of the coronavirus disease 2019(COVID-19)response to avert healthcare system collapse.Total hip arthroplasty(THA)and total knee arthroplasty(TKA)procedures comprise the highest volume of elective procedures performed at health care facilities worldwide.AIM To determine the demand for TJA despite the pandemic and the impact of surgery postponement on physical and mental health.METHODS We conducted a prospective cross-sectional telephonic interview-based study on patients awaiting THA and TKA at an academic institution in South Africa.The questionnaire consisted of four sections.The first section recorded baseline demographic data and medical co-morbidities,the length of time spent awaiting TJA,and the patients’desire to undergo elective surgery despite the COVID-19 pandemic.Section 2 and Section 3 assessed the patients’current physical and mental health,respectively,as a consequence of deferred surgical intervention.The last section established the patients’perception of the healthcare system’s response to the COVID-19 pandemic and necessity to postpone elective surgery.Patients received counseling and education on the current state of surgery during the COVID-19 pandemic and associated risks.Thereafter,patients were once again asked about their desire to undergo TJA during the COVID-19 pandemic.RESULTS We included 185 patients(65.95%female;mean age:50.28 years)awaiting TJA for a mean of 26.42±30.1 mo.Overall,88.65%of patients wanted TJA despite the COVID-19 pandemic.Patients awaiting TJA for 1-3 years were 3.3-fold more likely to want surgery than those waiting<1 year(P<0.000).Patients with comorbidities were 8.4-fold less likely to want TJA than those with no comorbidities(P=0.013).After receiving education,the patients wanting TJA decreased to 54.05%.Patients who changed their opinion after education had less insight on the increased morbidity(P=0.046)and mortality(P=0.001)associated with COVID-19.Despite awaiting TJA for shorter period(24.7±20.38 mo),patients who continued to demand TJA had greater pain(P<0.000)and decreased function(P=0.043)since TJA postponement.CONCLUSION There is deterioration in health for patients,who have had elective procedures postponed during the COVID-19 pandemic.Waiting lists should be prioritized for urgency with the re-initiation of elective surgery.

Reducing Paediatric Outpatient Waitlists—A Proposed Allied Health Multidisciplinary Approach

Extremely long Australian paediatric outpatient waiting lists have resulted in large numbers of children waiting to see a paediatrician. Analyses of the patient referrals suggest that a large proportion of children may benefit from allied health input, in addition to being seen by the paediatrician. This paper provides an organisational strategy that involves streamlining Allied Health clinical services in an effort to assist with bringing down a Paediatric Out-patient waitlist. The paper describes principles to guide the formation of a Paediatric Allied Health Multi-Disciplinary team that proposes assessment and brief interventions. The service would focus on supporting the paediatricians through the use of structured procedures, telephone intakes, multidisciplinary triage, shared and standardised assessments, collaborative formulations and reports, brief interventions, clinical-community linkages, and allied health student support. A variety of additional important organisational principles are proposed to facilitate patient flow from the perspective of streamlining administrative processes, having adequate administrative support, shared responsibilities, teamwork, flexibility, carrying out intake assessments, determining which referrals were appropriate for allied health, and working closely with medical staff.

Obesity and bariatric surgery in kidney transplantation:A clinical review

Obesity is increasing worldwide,and this has major implications in the setting of kidney transplantation.Patients with obesity may have limited access to transplantation and increased posttransplant morbidity and mortality.Most transplant centers incorporate interventions aiming to target obesity in kidney transplant candidates,including dietary education and lifestyle modifications.For those failing nutritional restriction and medical therapy,the use of bariatric surgery may increase the transplant candidacy of patients with obesity and endstage renal disease(ESRD)and may potentially improve the immediate and late outcomes.Bariatric surgery in ESRD patients is associated with weight loss ranging from 29.8% to 72.8% excess weight loss,with reported mortality and morbidity rates of 2% and 7%,respectively.The most commonly performed bariatric surgical procedures in patients with ESRD and in transplant patients are laparoscopic sleeve gastrectomy(LSG)and laparoscopic Roux-en-Y gastric bypass.However,the correct timing of bariatric surgery and the ideal type of surgery have yet to be determined,although pretransplant LSG seems to be associated with an acceptable risk-benefit profile.We review the impact of obesity on kidney transplant candidates and recipients and in potential living kidney donors,exploring the potential impact of bariatric surgery in addressing obesity in these populations,thereby potentially improving posttransplant outcomes.

Liver transplant allocation policies and outcomes in United States: A comprehensive review

Liver transplant allocation policies in the United States has evolved over 3 decades.The donor liver organs are matched,allocated and procured by the Organ Procurement and Transplantation Network which is administered by the United Network of Organ Sharing(UNOS),a not-for-profit organization governed by the United States human health services.We reviewed the evolution of liver transplant allocation policies.Prior to 2002,UNOS used Child-Turcotte-Pugh score to list and stratify patients for liver transplantation(LT).After 2002,UNOS changed its allocation policy based on model for end-stage liver disease(MELD)score.The serum sodium is the independent indicator of mortality risk in patients with chronic liver disease.The priority assignment of MELD-sodium score resulted in LT and prevented mortality on waitlist.MELD-Sodium score was implemented for liver allocation policy in 2016.Prior to the current and most recent policy,livers from adult donors were matched first to the status 1A/1B patients located within the boundaries of the UNOS regions and donor-service areas(DSA).We reviewed the disadvantages of the DSA-based allocation policies and the advantages of the newest acuity circle allocation model.We then reviewed the standard and non-standard indications for MELD exceptions and the decision-making process of the National Review Liver Review Board.Finally,we reviewed the liver transplant waitlist,donation and survival outcomes in the United States.