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Good afternoon. On behalf of the Department of Orthopaedics, I will be presenting an audit of our work in the last calender year
We will first start with the Emergency services provided by the department
The Trauma Centre Casualty saw an annual footfall of 69551 patients of which 26376 patients constituting 38% of the total received an ORTHO consultation. Most of these patients were triaged into the Green area of the Casualty. Both of these figures show an increase compared to the previous year.
We had to transfer out or regret as many as 1498 patients due to lack of availability of beds
We have had in excess of 1000 admissions in each of the last 4 years. This year we had an average of 118 admissions per month and about 27 consultations per week.
Thanks to the help of our Anaesthesia colleagues and the ICU back-up available for spine, pelvis and geriatric patients – our mortality rate has been very low and we had only a mortality of only 7 patients
Total bed occupancy rate for 2016 was 95%. Open fractures and spine fractures have longer admission periods.
Coming next to the Critical care admissions in 2016
Most of our ICU patients are not primary admissions but rather shifted to ICU post-operatively or due to medical complications. Last year 43 of our patients were admitted in ICU with 19 polytrauma patients, 5 patients with pelvic fractures, 13 spine patients and 6 patients who belonged to the geraitric age group.
Of the 43 admissions, 7 died and 36 were shifted back to the ward.
Next we Come to the OPD part….
In the last year, we had over 20000 OPD visits which include both new registrations and re-visits accounting for just over 50% of the total OPD load at trauma centre. At present we do not have a walk-in OPD so all of these patients are follow-up patients initially seen in casualty or patients discharged from the ward.
The number of patients attending ORTHO OPD has been on a steady rise in the last three years, with 2016 seeing a footfall of over 20000 patients
These pictures tell us a story we see on every OPD day…even at 2pm we have patients waiting to be seen and this is also the time for the next OPD. The solution to this could be to increase the OPD timings or the number of OPD rooms.
In 2016, of the 20000 odd patients that we saw, 8886 were new registrations and 11565 were revisits.
In 2016, over 11000 office procedures which includes dressing, suture removal and plster of paris application were carried out. Amost 50% of these procedures were plaster applications because of the high number of patients following up from the casualty. This brings out the need for having 1-2 skilled plaster technicians in the OPD
In 2016, we performed 1745 surgeries – 1680 major, 65 minor – 5 surgeries per day. 15 surgeries per day performed in trauma centre overall . The monthwise distribution of surgeries shows a slight dip between May to July which are the months when some of the consultants are on vacation.
951 cases amounting to 54% were routine cases, 794 46% were emergency cases which included local procedures done in OT.
Both our routine and emergency cases number has been high over the last 3 years.
In concordance with the epidemiological trends, males account for 78% of the surgeries done.
If we categroize these surgeries into axial and appendicular portions of the skeleton, spine and pelviacetabular fractures accoutned for 212 surgeries. [12%]
A total of 95 spine surgeries were done in 2016 – of which xx were cervical spine, xx were dorsal spine and xx were lumbar spine. 15 discectomies were also done.
Our centre records the maximum number of pelvis and acetabulum surgeries in india.
117 pelvi-acetabular surgeries were done in 2016 – which includes definitive fixation and emergency pelvic fixators or C-clamp applictions.
Consistent with the increasing prevalence of geriatric trauma and osteoporosis, we saw an increase in the number of proximal femur fractures that were operated by either intra-meduallary, extra-meduallry fixation or hemi replacement or total hip arthroplasties.
Coming to leg bones, we saw high numbers of complex peri-articular fractures being operated – 105 proximal tibia and over 90 dital tibia and malleolar fractures. Even signoficant numbers of rare fractures like talus and calcaneum were operated.
Upper limb trauma is fairly common and we saw high numbers of complex peri-articular fractures being operated. Modern implants and surgical techniques have been developed for distal radius fractures and are being used by us.
Most of the debridement and fixator are less . May be with help of surgeons go to surgery department
Bed Occupancy - 2016
• Total bed occupancy rate: 95% (Days of Care/Beds*days X100)
• Open fractures: mean 21 days
• Spine: mean 14 days
• Pelvis & Acetabulum : mean 9 days
• Peri articular fractures: mean 6 days
• Diaphyseal fractures: mean 3 days
• Upper limb fractures: mean 3 days
FRAGILITY FRACTURE CLINIC
Over 200 patients registered
Retrospective follow-up of
over 1000 patients
Research and project work
SPINE TRAUMA CLINIC
Every Monday morning
Increasing number of spine
HIGHEST NUMBER OF PELVI-
ACETABULAR SURGERIES IN INDIA
35% OF TOTAL SURGERIES
17 INDEXED PUBLICATIONS IN
2016 FROM ORTHOPAEDICS TEAM
REGIONAL AND NATIONAL
Challenges Ahead …..
GERIATRIC PATIENTS : SILENT EPIDEMIC ON THE RISE!
-- Establishment of geriatric trauma ward
-- Managing medical co-morbidities
NEED TO INCREASE BED CAPACITY IN WARDS
--Regretted patients (1498)
DEDICATED 24 HOURS EMERGENCY ORTHO OT
TO INCREASE THE OPD TIMINGS/OPD ROOMS
--51% of total OPD patients
-trained staff for the registry documentation