SummaryWe re-analysed prospective data collected by anaesthetists in the Anaesthesia Sprint Audit of Practice (ASAP-1) to describe associations with linked outcome data. Mortality was 165/11,085 (1.5%) 5 days and 563/11,085 (5.1%) 30 days after surgery and was not associated with anaesthetic technique (general vs. spinal, with or without peripheral nerve blockade). The risk of death increased as blood pressure fell: the odds ratio (95% CI) for mortality within five days after surgery was 0.983 (0.973-0.994) for each 5 mmHg intra-operative increment in systolic blood pressure, p = 0.0016, and 0.980 (0.967-0.993) for each mmHg increment in mean pressure, p = 0.0039. The equivalent odds ratios (95% CI) for 30-day mortality were 0.968 (0.951-0.985), p = 0.0003 and 0.976 (0.964-0.988), p = 0.0001, respectively. The lowest systolic blood pressure after intrathecal local anaesthetic relative to before induction was weakly correlated with a higher volume of subarachnoid bupivacaine: r 2 À0.10 and À0.16 for hyperbaric and isobaric bupivacaine, respectively. A mean 20% relative fall in systolic blood pressure correlated with an administered volume of 1.44 ml hyperbaric bupivacaine. Future research should focus on refining standardised anaesthesia towards administering lower doses of spinal (and general) anaesthesia and maintaining normotension.

Transformation matrices were used to track the changes. The AO classification was used to classify the fractures, with 85% being type A1 fractures.Results: A median of four radiographs were analysed for each patient (range 2-9), with a mean follow-up of 5.6 months (95% CI 4.1-7.1 months, max 49 months). Ninetytwo per cent of the cohort had sustained a 1 level injury. Seventy-six per cent of the injuries were between T12 and L2; 19% were in the thoracic spine. Mean changes in the parameters were: end plate angulation: −2.88 • ; anterior height: −6.15 mm; posterior height: −1.33 mm. The correlation between end plate angulation and anterior height loss was very good (r 2 = 0.83) and was fair between end plate angulation and posterior height loss (r 2 = 0.2). When analysing the collapse temporally, we found that the maximum collapse was in the first 200 days following the fracture.Conclusions: We report the use of Quality Motion Analysis software to track changes in the vertebral body geometry accurately. This has implications on the clinical aspects of management of thoraco-lumbar fractures based on the progression of deformity.Antibiotic-associated Clostridium difficile diarrhoea is an unwanted complication following surgery for proximal femoral fracture. It is associated with significant morbidity and mortality. Minimizing antibiotic exposure will help to reduce this problem. We sought to determine whether a change in antibiotic policy in our unit influenced rates of infection with C. difficile following hip fracture surgery.A change in antibiotic prophylaxis was introduced during a 3-month period in 2005. Infection rates with C. difficile were compared for the 15 months either side of this period. The initial regimen was one of three doses of cefuroxime (1.5 g). The new regimen is a single dose of cefuroxime (1.5 g) with gentamicin (240 mg) at induction. Infection was defined as diarrhoea with a positive isolate within 30 days of surgery.In the 15-month period prior to the change in prophylaxis, 579 patients underwent surgery for neck of femur fracture. In the same time period, following the change, 556 patients underwent surgery. Fourteen patients were diagnosed with C. difficile infection post-operatively (2.4%) in the initial group, compared with 4 patients (0.7%) in the group following the change in prophylaxis. This difference is statistically significant (p = 0.03). The average age in both the infected groups was 81 years.The main challenges regarding antibiotic selection are failure of prophylaxis, often because of infection with MRSA, and C. difficile-associated diarrhoea as a consequence of antibiotic prophylaxis. We changed our own policy to address theses issues. We have shown that infection with C. difficile is reduced with the new regimen. We therefore advocate the use of our new regimen as an effective alternative to multiple dose cephalosporins for the prevention of C. difficile infection in this group of patients.

Prospective data on hip fracture from 3686 patients at a United Kingdom teaching hospital were analysed to investigate the risk factors, financial costs and outcomes associated with deep or superficial wound infections after hip fracture surgery. In 1.2% (41) of patients a deep wound infection developed, and 1.1% (39) had a superficial wound infection. A total of 57 of 80 infections (71.3%) were due to Staphylococcus aureus and 39 (48.8%) were due to MRSA. No statistically significant pre-operative risk factors were detected. Length of stay, cost of treatment and pre-discharge mortality all significantly increased with deep wound infection. The one-year mortality was 30%, and this increased to 50% in those who developed an infection (p < 0.001). A deep infection resulted in doubled operative costs, tripled investigation costs and quadrupled ward costs. MRSA infection increased costs, length of stay, and pre-discharge mortality compared with non-MRSA infection.

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