Lightnews — Scholar-powered news

Reposted by Iain Moppett

Anaesthesia @anaesjournal.bsky.social · 10h

For daily updates straight to your phone, come and join us on WhatsApp!

whatsapp.com/channel/0029...

Iain Moppett @iainmoppett.bsky.social · 1d

We are most of the way through a trial of iv lidocaine during (not after) hip fracture surgery - delirium as outcome #AnSky www.ndorms.ox.ac.uk/research/cli...

WHiTE10

WHITE Platform Appendix 10 LIT

www.ndorms.ox.ac.uk

Iain Moppett @iainmoppett.bsky.social · 1d

ALLEGRO trial reported lack of benefit on GI function in minimally invasive surgery. #AnSky pubmed.ncbi.nlm.nih.gov/39602290/

Conclusions and relevance: Among patients undergoing elective minimally invasive colon resection, perioperative administration of 2% intravenous lidocaine did not improve return of gut function at 72 hours.

1

Reposted by Iain Moppett

Dr Mary-Ann Fox BMBS FANZCA GChPOM @maffygirl.medsky.social · 12d

Welcome back to the #MedSkyDebate from @bobfunn.bsky.social
What do you do?
IV Lignocaine yay or nay??
After a rush of enthusiasm in my primary hospital IV Lignocaine has disappeared.
I do not use it
Get involved #MedSky #AnSky

14 7 9

Reposted by Iain Moppett

Royal College of Anaesthetists @rcoanews.bsky.social · 5d

RCoA College Award - Dudley Buxton prize, to Dr Jude Partridge

RCoA College Award - President's Commendation, Jeff Handel

RCoA College Award - Honorary Fellowship: Mohammad Abdur Rahman

2 2

Reposted by Iain Moppett

Royal College of Anaesthetists @rcoanews.bsky.social · 5d

Congratulations to our College Award winners 🙌

🎖️College Medal: Caroline Evans, Alistair McKenzie, David Selwyn
🎖️Dudley Buxton: Jude Partridge
🎖️President's Commendation: Jeff Handel
🎖️Honorary Fellowship: Mohammad Abdur Rahman

Find out more 👉 ow.ly/sJwX50X4OQA

#Ansky #Medsky

RCoA College Medal winner Caroline Evans

RCoA College Medal winner Alistair McKenzie

2 4 8

Reposted by Iain Moppett

Iain Moppett @iainmoppett.bsky.social · 6d

Interesting workshop at #FFN2025 discussing variation, outcomes and unknowns around who doesn’t get an operation for #HipFracture. We recently published a big review of the international data @anaesjournal.bsky.social associationofanaesthetists-publications.onlinelibrary.wiley.com/doi/10.1111/...

associationofanaesthetists-publications.onlinelibrary.wiley.com

1 3

Iain Moppett @iainmoppett.bsky.social · 6d

That’s what happens when the flight home is delayed🤣 But too kind.

1

Iain Moppett @iainmoppett.bsky.social · 6d

In summary: there’s a lot of variation in rates of non-operative management of hip fracture; surgery remains the best option for the vast majority of people; we don’t have good data on what happens when non-operative management is chosen. Above all, put the patient at the heart of decision-making.

a german shepherd dog is sitting in a living room and looking at the camera .

Alt: a german shepherd dog is sitting in a living room and looking at the camera .

media.tenor.com

2

Iain Moppett @iainmoppett.bsky.social · 6d

The Fragility Fracture Network has form in this area – some great consensus statements on management of people with hip fracture taking DOACs here ;-)
pubmed.ncbi.nlm.nih.gov/38319797/

Principles for management of hip fracture for older adults taking direct oral anticoagulants: an international consensus statement - PubMed

Hip fracture is a common serious injury among older adults, yet the management of hip fractures for patients taking direct oral anticoagulants remains inconsistent worldwide. Drawing from a synthesis ...

pubmed.ncbi.nlm.nih.gov

1

Iain Moppett @iainmoppett.bsky.social · 6d

Given this variation in the number of people receiving non-operative management there is an opportunity for international networks such as the Fragility Fracture Network to put some markers down on principles to be followed. If you want to help follow the link.
redcap.mq.edu.au/surveys/?s=X...

$Details of how to opt in to the FFN Delphi on non-operative management and hip fracture. https://redcap.mq.edu.au/surveys/?s=XK4WF49A3NWT4KF7$

1

Iain Moppett @iainmoppett.bsky.social · 6d

The social, cultural and service delivery context of the Netherlands is unique. It is wrong to take their very carefully considered work in one context and transplant it unthinkingly somewhere else. The vast majority of people with #HipFracture will benefit from, and want, surgery.

a little girl with a pink bow on her head is holding a red book and says be very careful

Alt: a little girl with a pink bow on her head is holding a red book and says be very careful

media.tenor.com

1

Iain Moppett @iainmoppett.bsky.social · 6d

Hanna Willems and her colleagues have done some pioneering work in the Netherlands looking at the quality of life – and dying – in people living with marked frailty who chose not to have surgery. pubmed.ncbi.nlm.nih.gov/35234817/

$Top 5 goals of care in hip fracture: Being with family / partner Maintaining independence Preserving cognitive function Quality of life more important than prolonged life Return to pre-fracture mobility No pain (patients with dementia) Surgery will add to these goals! (in the majority of patients)$ $Quality of dying after non-operative and operative management of hip fracture. Generally good or intermediate. Some ‘terrible’ in both groups.$

1

Iain Moppett @iainmoppett.bsky.social · 6d

Epidemiological data tell us what happens (and there is a huge gap in the quality of survival for patients not getting surgery) but what about when non-operative management is (rarely) chosen by patients or their families?

a toy that says i have a question on it

Alt: a toy that says i have a question on it

media.tenor.com

1

Iain Moppett @iainmoppett.bsky.social · 6d

Antony Johansen (of NHFD fame) demonstrated nicely that the daily risk of dying in the early post-operative period is low – even for the highest risk patients.

1 1

Iain Moppett @iainmoppett.bsky.social · 6d

This is important when thinking about non-operative management. A significant number of people survive for a relatively unpredictable length of time. Around 80% of people at one month and 50% at one year.

Forest plot of relative risk of dying associated with non-operative management. Probably highest in hospital (around 5 time) and lower at one year (around double). Text also describes absolute 30-day mortality (1 in 5 for all-comers having non-operative management, 1 in 3 for higher risk patients) and 1 year mortality (1 in 2 for all comers, 2 in 3 for higher risk cohorts).

1 1

Iain Moppett @iainmoppett.bsky.social · 6d

Outcomes data are dominated by mortality. Risk of dying at all time points is greater in those having non-operative management of hip fracture. Partly patient selection, and the consequence of not operating and optimising symptom control over prolongation of the dying process.

1

Iain Moppett @iainmoppett.bsky.social · 6d

Variation in rates of surgery for #HipFracture are NOT fully explained by patient characteristics. The presence of dementia, cancer and higher ASA physical status (greater impact of comorbidities) are associated with non-op management. Something else is going on.

$Forest plot (central estimates and confidence interval lines of multiple characteristics) showing the estimated relative risk of receiving non-operative management for hip fracture. Sex, fracture type and ethnicity pretty clearly not associated with increased risk. Dementia, cancer, being less mobile and non-independence with ADLs (activities of daily living) are associated with increased risk of non-operative management. Not admitted from own home is unclear.$

1

Iain Moppett @iainmoppett.bsky.social · 6d

Bear in mind that in many parts of the world people may not even get to hospital with their #HipFracture. Many cultural, social and economic reasons for this as highlighted by Irewin Tabu from the Philippines.

$Alt text: Tables and figures from scientific papers. Of 181 people not having surgery for hip fracture, around 32% didn’t give consent, 7% it was clinician choice, 7% didn’t have implants available, 5% were (to paraphrase) thought to be too ill, 3 or 181 couldn’t afford it.$

1

Iain Moppett @iainmoppett.bsky.social · 6d

Overall, around 1 in 12 patients who get to hospital don’t have surgery for their broken hip – but there is a lot of intra-country and inter-regional variation

Box and whisker plots showing median, interquartile ranges and individual values for non-operative proportions categorised by world bank region (e.g. N America, S Asia, Europe and Central Asia etc.) Some differences in medians (around 8%) but most striking is wide variation in all regions. In general proportions are higher in ‘higher risk’ cohorts (e.g. those defined as older, or frailer, from nursing homes etc.) though no clear separation between those and unselected (all-comers) cohorts.

1 1

Iain Moppett @iainmoppett.bsky.social · 6d

Internationally, data are sparse – overrepresentation of higher income countries – both for who get an operation for #HipFracture and for important outcomes afterwards

$World map showing where there are data reporting data comparing operative and non-operative management of hip fracture. Concentrated in the global north (though fewer data from Europe than might be expected)$

1

Iain Moppett @iainmoppett.bsky.social · 6d

Interesting workshop at #FFN2025 discussing variation, outcomes and unknowns around who doesn’t get an operation for #HipFracture. We recently published a big review of the international data @anaesjournal.bsky.social associationofanaesthetists-publications.onlinelibrary.wiley.com/doi/10.1111/...

associationofanaesthetists-publications.onlinelibrary.wiley.com

1 3

Iain Moppett @iainmoppett.bsky.social · 13d

Delighted to have you joining the @anaesjournal.bsky.social team, Danny. A Leo obviously 😉

leonardo dicaprio is wearing a tuxedo and bow tie and smiling with the words yasssss written below him

Alt: leonardo dicaprio is wearing a tuxedo and bow tie and smiling with the words yasssss written below him

media.tenor.com

1 1

Reposted by Iain Moppett

Danny Wong (黄永年) @dannyjnwong.bsky.social · 20d

I’m happy to share that I have been appointed as an Editor at @anaesjournal.bsky.social! Excited to start contributing to evidence based medicine and forwarding anaesthetic and scientific knowledge from the other side of the peer review process!

8 5 45

Reposted by Iain Moppett

Anaesthesia @anaesjournal.bsky.social · 20d

The National Safety Standards for Invasive Procedures (NatSSIPS) sequential step standards (`NatSSIPs eight´) that should be implemented for invasive procedures.

#AnSky #MedSky

doi.org/10.1111/anae...

2 2