Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

The influence of first ray instability and hindfoot valgus in the development of hallux rigidus: state of art

: Hallux rigidus (HR) is a painful condition associated with degenerative arthritis of the first metatarsophalangeal (MTP1) joint, leading to a progressive loss of dorsiflexion. The etiological factors leading to the development of the condition are not yet fully understood in the literature. When the hindfoot is aligned in excessive valgus, the medial border of the foot tends to roll over, which brings to increased stress on the medial side of the MTP1 joint, and consequently on the first ray (FR), thus potentially influencing the development of HR deformity. This state of art aims to analyze the influence of FR instability and hindfoot valgus in HR development. From the results of the analyzed studies, it appears that a FR instability may predispose the big toe to increased stress and to narrow the proximal phalanx motion on the first metatarsal, which brings to compression and ultimately degeneration of the MTP1 joint, mostly in advanced stages of disease, less in mild or moderate HR patients. A strong correlation between a pronated foot and MTP1 joint pain was found; forefoot hypermobility during the propulsion phase may promote MTP1 joint instability and increase pain. Thus, the increased moment of pronation of the foot with the overload of the medial column, when present, should be corrected conservatively or surgically; this, most likely, would be useful not only to eliminate or at least limit the painful symptoms but above all to prevent the worsening of the condition, also after the surgical treatment of HR

May footwear be a predisposing factor for the development of hallux rigidus? A review of recent findings

Hallux rigidus (HR) is the clinical manifestation of osteoarthritis of the first metatarsophalangeal (MTP1) joint and affects about 2.5% of people older than 50 years. The condition may significantly impact patients' quality of life, leading to debilitating pain and limited range of motion (ROM). Numerous hypotheses have been postulated about contributing factors to the development of the disease, but with poor proven association. Some types of footwear over others may transmit altered pressure and stress toward the forefoot and this can significantly contribute to development of the condition. The purpose of this review is therefore to analyze the importance of correct footwear and if an incorrect shoe can influence the development and/or worsening of symptoms in patients affected by HR. From the results of the studies, it appears that symptoms improve with rigid-soled low-heeled shoes such as boots and worsen with flat flexible-soled shoes such as sandals and tennis shoes, which should therefore be avoided. Despite this, although incorrect footwear increases symptoms, a direct correlation with the development of the condition has not been detected but rather an improvement in comfort in some types of shoes than in others. In predisposed patients, incorrect footwear is more a way to increase symptoms than a real risk factor for the development of the disease, remaining in a very low risk percentage to be considered indicative

Clinical and radiological union rate evaluation of type 2 odontoid fractures: A comparison between anterior screw fixation and halo vest in elderly patients

Purpose: Odontoid fracture is a very common cervical injury, especially in elderly patients. Despite the high frequency, the appropriate management is still debated. The aim of this study is to evaluate clinical and radiological outcomes after anterior screw fixation or halo vest (HV) in type II odontoid fracture in elderly patients. Materials and Methods: Between January 2013 and December 2015, 135 consecutive patients affected by odontoid process were found. According to inclusion and exclusion criteria, 57 patients were included in the study. Patients were evaluated with visual analog scale (VAS), Smiley–Webster Scale (SWS), Italian Version of the Neck Disability Index (NDI), and patient satisfaction during follow-up. Furthermore, radiological data were evaluated for bone healing. Student's t-test or Fisher's exact test was used between groups, analyzing radiological and clinical results, and level of statistical significance was set at P < 0.05. Results: Seventeen patients were female and 40 were male. Twenty-seven patients were included in surgical group (SG) while 30 were included in HV group with a mean follow-up of 37.74 ± 10.52 months. A significant difference (P 0.05); SG reached higher satisfaction than HV group (P = 0.0271). Conclusions: Both treatments are equivalent in terms of clinical outcomes, and they are a valuable choice in the management of type II odontoid fracture. However, it must be considered that patients could slightly tolerate HV and may need a change of treatment

ACUTE DESTRUCTIVE HIP SEPTIC ARTHRITIS IN A YOUNG ADULT PATIENT: CASE REPORT (v2)

The Authors describe a case of rapid right hip destructive septic arthritis in a 50-year-old male patient with no previous noteworthy medical history. Patient arrived to our attention following a one week history of right hip pain. Laboratory markers and imaging at presentation were negative. However, on a follow-up examination significant joint effusion was noted and joint tap was performed. Despite wide spectrum antibiotic therapy institution, significant joint damage was observed. This required surgical femoral head excision with antibiotic loaded spacer, followed by hip arthroplasty surgery 12 weeks afterwards. Complete healing of the infection and recovery of pain-free joint motion was noted at 1 year follow-up

Is vertebral stenting kyphoplasty a good choice in the treatment of osteoporotic vertebral fracture? A series of 47 patients (v2)

Background: The incidence of vertebral fragility fracture is increasing over last three decades with an essential impact on quality of life. Some devices were proposed to improve conventional kyphoplasty in the last five years, known as vertebral stenting kyphoplasty (VSK). Materials and methods: All osteoporotic vertebral fractures (OVF) treated with VSK, single-level fracture without neurological impairment, and with more than 24 months of follow-up were included in the study. We recorded fracture types according to DGOU classification, fracture level, regional kyphosis angle (RKA), Oswestry disability index (ODI), and complications. Results: Forty-seven consecutive patients were included. RKA significantly improved from pre to postoperative values (p&lt;0.000001) and to follow-up values (p&lt;0.00001). A significant difference was found between preoperative RKA of (OF2+OF3) and OF4 (p&lt;0.00001), confirmed immediately after surgery (p= 0.005425) and at last follow up (p= 0.000947). A significant difference was found in correction of RKA between (OF2+OF3) and OF4 at injury time and after treatment (p&lt;0.00001), and it was confirmed at the last follow-up (p=0.000026). ODI showed a significant difference between (OF2+OF3) and OF4 type of fractures (p=0.038216). We recorded five complications: 2 cases of leakage without neurological impairment, two progressions of kyphosis, and one implant migration. Conclusions: VSK is an excellent and reliable option in the treatment of OVF, with good clinical results and preservation of obtained RKA at the time of treatment. However, in case of vertebral collapse with the involvement of both vertebral plates, surgeons must be aware of possible implant failure or migration. Level of evidence: 4