ORCID Profile
0000-0003-1404-9983
Current Organisation
John Hunter Hospital
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Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 03-2013
Publisher: Elsevier BV
Date: 08-2020
Publisher: Wiley
Date: 15-05-2013
DOI: 10.1111/ANS.12200
Abstract: Muscle hernias are uncommon clinical conditions with no uniform solution of repair. Biocompatible mesh allows for repair of hernias without the donor site morbidity and complications from direct repair under tension. Over a 6-month period at a Level 1 Trauma centre, four consecutive symptomatic muscle hernias were identified, two in the forearm and two in the lower limb. Three resulted from high-speed motorbike accidents, one from a mining accident. All patients had hernia repair at a minimum of 4 months post accident. A 10 × 15 cm × 1.0 mm sheet of acellular collagen matrix was fashioned to fit as an underlay of the fascia defect. Patients were clinically followed at the 2-, 6-, 12- and 26-week mark. Final phone contact was made 18 months post-operatively. All patients were pleased with their cosmetic and functional outcomes. All patients returned to work and sport 3 months after reconstruction. Symptomatic hernias as a result of trauma can be safely reconstructed with a biological mesh implant. This approach can prevent complications from previously described methods and return to active lifestyles with good results.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 10-2014
Publisher: Springer Science and Business Media LLC
Date: 19-09-2013
DOI: 10.1007/S11657-013-0150-3
Abstract: The aim of this study was to describe the population-based longitudinal trends in incidence, 30-day mortality and length of stay of hip fracture patients in a tertiary referral trauma centre in Newcastle, New South Wales, Australia, and identify the factors associated with increased 30-day mortality. A retrospective database and chart review was conducted to patients aged ≥65 years with a diagnosis of femoral neck or pertrochanteric fracture admitted to the John Hunter Hospital between 01 January 2002 and 30 December 2011. The main outcome measure was 30-day mortality secondary outcome was acute length of stay. There were 4,269 eligible patients (427±20 per year) with hip fractures over the 10-year study period. The absolute incidence increased slightly (p=0.1) but the age-adjusted rate decreased (p≤0.0001). The average age (83.5±7.1 years) and percentage of females (73.7%) did not change. Length of stay increased by a factor of 2.5% per year (p<0.0001). Thirty-day mortality decreased from 12.3% in 2002 to 8.20% in 2011 (p=0.0008). Independent risk factors associated with increased 30-day mortality were longer admissions (p<0.0001), increased age (p=0.005), dementia (p=0.01), male gender (p<0.0001), higher American Society of Anaesthesiologists score (p<0.0001), and longer time to operating theatre (p=0.002). Despite the relative ageing of our population, a decrease in the age-standardised rate of fractured hip in elderly patients has seen the number of admissions remain unchanged in our institution from 2002 to 2011. There was a decrease in 30-day mortality, while length of stay increased.
Publisher: Springer Science and Business Media LLC
Date: 15-03-2022
DOI: 10.1007/S00068-022-01939-6
Abstract: We hypothesized that unrestricted or full weight-bearing (FWB) in hip fracture would increase the opportunity to mobilize on post-operative day 1 (POD1mob) and be associated with better outcomes compared with restricted weight-bearing (RWB). Over 4 years, 1514 geriatric hip fracture patients aged 65 and above were prospectively recruited. Outcomes were compared between FWB and RWB patients. The primary outcome was 30-day mortality. Secondary outcomes were immobility-related adverse events, length of stay (LOS), and reoperation for failure. Causal effect modelling and multivariate regression with mediation analyses were performed to examine the relation between weight-bearing status (WBS), POD1mob, and known mortality predictors. FWB was allowed in 1421 (96%) of 1479 surgically treated patients and RWB enforced in 58 (4%) patients. Mortality within 30 days occurred in 141 (9.9%) of FWB and 3 (5.2%) of RWB patients. In adjusted analysis, RWB did not influence 30-day mortality (OR 0.42, 95% CI 0.15–01.13, p = 0.293), with the WBS accounting for 91% of the total effect on mortality and 9% contributed from how WBS influenced the POD1mob. RWB was significantly related to increased DVT (OR 7.81, 95% CI: 1.81–33.71 p = 0.002) but no other secondary outcomes. Patients that did not have the opportunity to mobilize had increased 30-day mortality (OR 2.31, 95% CI 1.53–3.48 p 0.001). Restricted weight-bearing was not associated with increased 30-day mortality. Only a small proportion of this effect was mediated by POD1mob. Whilst post-surgical WBS may be difficult to influence for cultural reasons, POD1mob is an easily modifiable target that is likely to have a greater effect on 30-day mortality. Level III, observational study.
Publisher: Springer Science and Business Media LLC
Date: 17-01-2023
DOI: 10.1007/S00268-023-06897-7
Abstract: Pelvic fracture-associated bleeding can be difficult to control with historically high mortality rates. The impact of resuscitation advancements for trauma patients with unstable pelvic ring injuries is unknown. We hypothesized that the time elapsed since introduction of our protocol would be associated with decreased blood transfusion requirements. A level 1 trauma center’s prospective pelvic fracture database was reviewed from 01/01/2009–31/12/2018. All patients with unstable pelvic ring injuries initially presenting to our institution were included. Adjusted regression analysis was performed on the overall cohort and separately for patients in traumatic shock (TS). The primary outcome was 24 h packed red blood cell (PRBC) requirements. Secondary outcomes were 24 h plasma, cryoprecipitate, platelet and intravenous fluid (IVF) requirements, length of stay and mortality. Patients with mechanically unstable pelvic ring injuries ( n = 144, median [Q 1 –Q 3 ] age 44 [28–55] years, 74% male) received a median (Q 1 –Q 3 ) of 0 (0–4) units PRBC within 24 h, with TS patients ( n = 47, 42 [28–60] years, 74% male) receiving 6 (4–9) units PRBC. There was no decrease in 24 h PRBC requirements for the overall cohort (years IRR = 0.91, 95% CI 0.83–1.01 p = 0.07). TS patients had decreases in 24 h PRBC (years IRR = 0.90, 95%CI 0.84–0.96 p = 0.002), plasma (IRR = 0.92, 95%CI 0.85–0.99 p = 0.019), cryoprecipitate (IRR = 0.88, 95%CI 0.81–0.95 p = 0.001) and IVF (IRR = 0.94, 95%CI 0.90–0.98 p = 0.004). There were 5 deaths (5/144, 3.5%) with no deaths due to acute hemorrhage. Over this 10-year period, there was no hemorrhage-related mortality among patients presenting with pelvic fractures. Crystalloid and transfusion requirements decreased for patients presenting with traumatic shock.
Publisher: British Editorial Society of Bone & Joint Surgery
Date: 09-2014
DOI: 10.1302/0301-620X.96B9.32814
Abstract: There is a high rate of mortality in elderly patients who sustain a fracture of the hip. We aimed to determine the rate of preventable mortality and errors during the management of these patients. A 12 month prospective study was performed on patients aged 65 years who had sustained a fracture of the hip. This was conducted at a Level 1 Trauma Centre with no orthogeriatric service. A multidisciplinary review of the medical records by four specialists was performed to analyse errors of management and elements of preventable mortality. During 2011, there were 437 patients aged 65 years admitted with a fracture of the hip (85 years (66 to 99)) and 20 died while in hospital (86.3 years (67 to 96)). A total of 152 errors were identified in the 80 in idual reviews of the 20 deaths. A total of 99 errors (65%) were thought to have at least a moderate effect on death 45 reviews considering death (57%) were thought to have potentially been preventable. Agreement between the panel of reviewers on the preventability of death was fair. A larger-scale assessment of preventable mortality in elderly patients who sustain a fracture of the hip is required. Multidisciplinary review panels could be considered as part of the quality assurance process in the management of these patients. Cite this article: Bone Joint J 2014 -B:1178–84.
No related grants have been discovered for Seth Tarrant.