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  1. Article: Length of hospital stay following hip fracture and risk of 30 and 90 day mortality in a United Kingdom cohort.

    Sheikh, Hassaan Q / Alnahhal, Amro / Aqil, Adeel / Hossain, Fahad S

    Acta orthopaedica Belgica

    2022  Volume 87, Issue 4, Page(s) 607–617

    Abstract: A recent study identified a length of stay (LOS) of 10 days or less following hip fracture is associated with increased risk of 30-day mortality. This effect has not been previously studied for 90-day mortality or in the United Kingdom (UK). Our aim was ... ...

    Abstract A recent study identified a length of stay (LOS) of 10 days or less following hip fracture is associated with increased risk of 30-day mortality. This effect has not been previously studied for 90-day mortality or in the United Kingdom (UK). Our aim was to investigate the effect of LOS on 30-day and 90-day mortality following hip fracture in a UK population. In this single-centre study, we retrospectively identified consecutive patients with a hip fracture from the National Hip Fracture Database over 3 years. We excluded patients who died as inpatient during their index admission. The main end-points were 30-day and 90-day mortalities and risk factors for these were examined using stepwise univariate and multivariate Cox regression analyses. Of 1228 patients, mortality at 30-days was 1.2% (15 patients) and 7.8% (96 patients) at 90-days. Mean LOS was 24 days and a total of 206 patients had a LOS of 10 days or less. Following cariate analysis, the highest risk factor for 30-day mortality was a LOS of 10 days or less with a hazard ratio of 7.26 (95% confidence interval 2.56-20.51). Other risk factors for 30-day mortality included increasing age, male gender and chest infection. A LOS of 10 days or less was not associated with increased mortality at 90-days. A short LOS was associated with higher risk of early mortality. We recommend that hip fracture patients be fully rehabilitated prior to discharge to reduce the risk of early mortality.
    MeSH term(s) Cohort Studies ; Hip Fractures ; Humans ; Length of Stay ; Male ; Patient Discharge ; Retrospective Studies ; Risk Factors
    Language English
    Publishing date 2022-02-16
    Publishing country Belgium
    Document type Journal Article
    ZDB-ID 210367-9
    ISSN 0001-6462 ; 1784-407X
    ISSN 0001-6462 ; 1784-407X
    DOI 10.52628/87.4.05
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  2. Article ; Online: Covid-19: Exploring medico-legal perceptions amongst orthopaedic surgeons and lawyers.

    Seraj, Shaikh S / Khadabadi, Nikhil A / Jawaid, Anam / Logan, Peter C / Moores, Thomas S / Hossain, Fahad S

    The Medico-legal journal

    2023  Volume 91, Issue 2, Page(s) 102–108

    Abstract: Introduction: British national guidelines and laws published by the British Orthopaedic Association and the new Coronovirus Act 2020 favoured treatment of trauma and orthopaedic conditions with non-operative alternatives.A survey was developed for both ... ...

    Abstract Introduction: British national guidelines and laws published by the British Orthopaedic Association and the new Coronovirus Act 2020 favoured treatment of trauma and orthopaedic conditions with non-operative alternatives.A survey was developed for both lawyers and trauma and orthopaedic clinicians to gauge their perceptions on guidelines related to protection of trauma and orthopaedic staff, and on prosecution with respect to future claims.
    Material and methods: Sixteen questions were designed for surgeons and 11 questions for lawyers. The level of experience and career stages were explored in other questions. A Likert scale (0-5) was used to capture these perceptions.
    Results: Clinicians envisaged themselves being less protected (mean = 2.6), forecasted a rise in negligence claims (mean = 3.4) and perceived little additional beneficial indemnity influence from the NHS (mean = 1.8). Lawyers felt that public perception would have more influence in negligence claim rates (mean = 2.6) and disapproved of complete immunity for clinicians (mean = 0.5). Disparities between different trauma and orthopaedic grades demonstrated sentiments of comfort with redeployment, preparedness in non-orthopaedic training and protection from litigation.
    Discussion: The results reflected the overall anxiety over litigation reprisal shared amongst trauma and orthopaedic staff. Issues with providing sub-optimal care can worsen this overall fear. Feeling unprotected from litigation reprisal can leave clinicians with an additional sense of emotional and professional burden. Redeployment into unfamiliar environments can leave senior clinicians in limbo in contrast to their juniors.
    Conclusion: Non-surgical options to treat orthopaedic conditions affect both patients and trauma and orthopaedic staff. Feedback from lawyers reassures trauma and orthopaedic clinicians that negligence claims should not rise due to the updated national guidelines.
    MeSH term(s) Humans ; Lawyers ; Orthopedic Surgeons ; COVID-19 ; Malpractice ; State Medicine
    Language English
    Publishing date 2023-01-25
    Publishing country England
    Document type Journal Article
    ZDB-ID 390918-9
    ISSN 2042-1834 ; 0025-8172
    ISSN (online) 2042-1834
    ISSN 0025-8172
    DOI 10.1177/00258172221146397
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  3. Article: Short-term risk factors for a second hip fracture in a UK population.

    Sheikh, Hassaan Q / Hossain, Fahad S / Khan, Sayeed / Usman, Mohammad / Kapoor, Harish / Aqil, Adeel

    European journal of orthopaedic surgery & traumatology : orthopedie traumatologie

    2019  Volume 29, Issue 5, Page(s) 1055–1060

    Abstract: Introduction: A hip fracture carries significant morbidity and mortality-a second fracture of the contralateral hip carries even higher complications. Most second hip fractures occur within 48 months of the first. The aim of this study was to ... ...

    Abstract Introduction: A hip fracture carries significant morbidity and mortality-a second fracture of the contralateral hip carries even higher complications. Most second hip fractures occur within 48 months of the first. The aim of this study was to comprehensively analyse all identifiable variables that may increase the risk of a contralateral hip fracture within this time period.
    Methods: We retrospectively analysed 1242 consecutive patients with hip fractures presenting to our institution. All patient-related, surgery-related and inpatient variables were collected from the index admission. We then identified patients with a subsequent contralateral hip fracture in the following 2 years. Univariate and multivariate analyses were performed to identify risk factors associated with a second fracture.
    Results: A total of 66 patients (5.3%) had a contralateral hip fracture in the 2 years following initial hip fracture. Mean age at first presentation was 81 years, and mean time to second fracture was 305 days. Following multivariate analysis, the patients at highest risk of a second fracture were those with dementia, acute inpatient chest infection, urinary tract infection and multiple comorbidities as measured by the Charlson score. Discharge destination after initial fracture was not associated with the risk of a second fracture.
    Conclusions: We have identified a number of discrete risk factors that are associated with a short- to medium-term risk of contralateral hip fracture that may be useful in screening for patients at risk and provide them with focused medical rehabilitation.
    MeSH term(s) Aged ; Aged, 80 and over ; Dementia/epidemiology ; Female ; Fracture Fixation/adverse effects ; Fracture Fixation/methods ; Frail Elderly/statistics & numerical data ; Hip Fractures/diagnosis ; Hip Fractures/epidemiology ; Hip Fractures/surgery ; Humans ; Male ; Multiple Chronic Conditions/epidemiology ; Osteoporotic Fractures/epidemiology ; Osteoporotic Fractures/surgery ; Patient Readmission/statistics & numerical data ; Postoperative Period ; Prognosis ; Retrospective Studies ; Risk Factors ; United Kingdom/epidemiology
    Language English
    Publishing date 2019-03-12
    Publishing country France
    Document type Journal Article
    ZDB-ID 1231084-0
    ISSN 1432-1068 ; 1633-8065 ; 0948-4817 ; 0940-3264
    ISSN (online) 1432-1068
    ISSN 1633-8065 ; 0948-4817 ; 0940-3264
    DOI 10.1007/s00590-019-02412-8
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    Zs.A 3479: Show issues Location:
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  4. Article: There is no weekend effect in hip fracture surgery - A comprehensive analysis of outcomes.

    Sheikh, Hassaan Q / Aqil, Adeel / Hossain, Fahad S / Kapoor, Harish

    The surgeon : journal of the Royal Colleges of Surgeons of Edinburgh and Ireland

    2017  Volume 16, Issue 5, Page(s) 259–264

    Abstract: Background: Previous studies have shown that some patient groups suffer adverse outcomes if they are acutely admitted to hospital over a weekend. We aimed to investigate this 'weekend effect' at our centre in patients presenting with a hip fracture.: ... ...

    Abstract Background: Previous studies have shown that some patient groups suffer adverse outcomes if they are acutely admitted to hospital over a weekend. We aimed to investigate this 'weekend effect' at our centre in patients presenting with a hip fracture.
    Methods: Consecutive patients undergoing acute hip fracture surgery were identified from a prospective database. Patient demographics, co-morbidities, fracture type, admission blood parameters were examined. Outcomes analysed included 30-day, 90-day and 1-year mortality as well as length of stay, re-operations and delay to surgery. The data were analysed with regards to day of admission and day of surgery separately.
    Results: A total of 1326 patients were included, of which 368 patients were admitted over a weekend and 411 patients had their operation over a weekend. Overall 30-day mortality was 7.6% (101 patients), whilst the 90-day and 1-year mortalities were 15.3% and 26.8% (203 and 356 patients). There were no significant differences in any of the outcomes based on the day of admission or the day of surgery. Multivariate analysis for 30-day mortality demonstrated the following variables to be significant predictors: admission urea levels (hazard ratio (HR) 1.042, p = 0.027), age (HR 1.058, p < 0.001), admission source (HR 1.428, p < 0.001), surgical delay >48 h (HR 1.853, p = 0.004), male gender (HR 1.967, p = 0.003), previous stroke (HR 2.261, p = 0.038), acute chest infection (4.240, p < 0.001) and chronic liver disease (HR 4.581, p = 0.014).
    Conclusion: This data suggests that there is no significant weekend effect in hip fracture surgery and mortality is affected by patient co-morbidities and delay to surgery.
    MeSH term(s) Adult ; Aged ; Aged, 80 and over ; Arthroplasty, Replacement, Hip/adverse effects ; Arthroplasty, Replacement, Hip/statistics & numerical data ; Comorbidity ; Databases, Factual ; Female ; Fracture Fixation, Internal/adverse effects ; Fracture Fixation, Internal/statistics & numerical data ; Hip Fractures/epidemiology ; Hip Fractures/mortality ; Hip Fractures/surgery ; Hospitalization/statistics & numerical data ; Humans ; Male ; Middle Aged ; Time Factors ; Time-to-Treatment ; United Kingdom/epidemiology ; Young Adult
    Language English
    Publishing date 2017-12-01
    Publishing country Scotland
    Document type Journal Article
    ZDB-ID 2102927-1
    ISSN 1479-666X
    ISSN 1479-666X
    DOI 10.1016/j.surge.2017.11.001
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    Zs.A 5756: Show issues Location:
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  5. Article: Panton-Valentine leukocidin osteomyelitis in children: a growing threat.

    Sheikh, Hassaan Q / Aqil, Adeel / Kirby, Andrew / Hossain, Fahad S

    British journal of hospital medicine (London, England : 2005)

    2015  Volume 76, Issue 1, Page(s) 18–24

    Abstract: Panton-Valentine leukocidin-producing Staphylococcus aureus osteomyelitis is associated with multiple complications including multiple abscesses, deep vein thrombosis and fulminant sepsis. This article reviews the literature concerning this emerging ... ...

    Abstract Panton-Valentine leukocidin-producing Staphylococcus aureus osteomyelitis is associated with multiple complications including multiple abscesses, deep vein thrombosis and fulminant sepsis. This article reviews the literature concerning this emerging threat which is currently under-recognized.
    MeSH term(s) Anti-Bacterial Agents/therapeutic use ; Bacterial Toxins/metabolism ; Child ; Debridement ; Exotoxins/metabolism ; Humans ; Leukocidins/metabolism ; Osteomyelitis/complications ; Osteomyelitis/diagnosis ; Osteomyelitis/therapy ; Pyomyositis/etiology ; Sepsis/etiology ; Severity of Illness Index ; Staphylococcal Infections/complications ; Staphylococcal Infections/diagnosis ; Staphylococcal Infections/therapy ; Staphylococcus aureus/metabolism ; Venous Thrombosis/etiology
    Chemical Substances Anti-Bacterial Agents ; Bacterial Toxins ; Exotoxins ; Leukocidins ; Panton-Valentine leukocidin
    Language English
    Publishing date 2015-01
    Publishing country England
    Document type Journal Article ; Review
    ISSN 1750-8460
    ISSN 1750-8460
    DOI 10.12968/hmed.2015.76.1.18
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  6. Article: Prevention of limb length discrepancy in total hip arthroplasty.

    Kayani, Babar / Pietrzak, Jurek / Hossain, Fahad S / Konan, Sujith / Haddad, Fares S

    British journal of hospital medicine (London, England : 2005)

    2017  Volume 78, Issue 7, Page(s) 385–390

    Abstract: Total hip arthroplasty is a highly effective and cost-efficient procedure but postoperative limb length discrepancy is a common source of patient dissatisfaction and litigation. This article provides a systematic, stepwise approach for identifying and ... ...

    Abstract Total hip arthroplasty is a highly effective and cost-efficient procedure but postoperative limb length discrepancy is a common source of patient dissatisfaction and litigation. This article provides a systematic, stepwise approach for identifying and proactively managing risk factors associated with limb length discrepancy following total hip arthroplasty. This review explores preoperative history taking, clinical examination, radiological templating, implant positioning, soft tissue balancing, and intraoperative surgical techniques for minimizing leg length discrepancy while maintaining stability and restoring mechanical function following total hip arthroplasty. A comprehensive understanding of the multifactorial nature and methods for reducing postoperative limb length discrepancy is essential for optimizing patient satisfaction, clinical outcomes and long-term function following total hip arthroplasty.
    MeSH term(s) Arthroplasty, Replacement, Hip/adverse effects ; Hip Prosthesis ; Humans ; Leg Length Inequality/etiology ; Leg Length Inequality/prevention & control ; Patient Satisfaction ; Postoperative Complications/etiology ; Postoperative Complications/prevention & control
    Language English
    Publishing date 2017-07-02
    Publishing country England
    Document type Journal Article ; Review
    ISSN 1750-8460
    ISSN 1750-8460
    DOI 10.12968/hmed.2017.78.7.385
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  7. Article ; Online: Is discontinuation of clopidogrel necessary for intracapsular hip fracture surgery? Analysis of 102 hemiarthroplasties.

    Hossain, Fahad S / Rambani, Rohit / Ribee, Helen / Koch, Lutz

    Journal of orthopaedics and traumatology : official journal of the Italian Society of Orthopaedics and Traumatology

    2013  Volume 14, Issue 3, Page(s) 171–177

    Abstract: Background: An increasing number of elderly patients are managed with long-term antiplatelet therapy. Such patients often present with hip fracture requiring surgical intervention and may be at increased risk of perioperative bleeding and complications. ...

    Abstract Background: An increasing number of elderly patients are managed with long-term antiplatelet therapy. Such patients often present with hip fracture requiring surgical intervention and may be at increased risk of perioperative bleeding and complications. The aim of this study was to ascertain whether it is necessary to stop clopidogrel preoperatively to avoid postoperative complications following hip hemiarthroplasty surgery in patients with intracapsular hip fracture.
    Materials and methods: A retrospective review of 102 patients with intracapsular hip fracture with either perioperative clopidogrel therapy [clopidogrel group (CG)] or no previous clopidogrel exposure [no clopidogrel group (NCG)] who underwent hip hemiarthroplasty surgery was undertaken. Statistical comparison on pre- and postoperative haemoglobin, American Society of Anesthesiologists (ASA) grade, comorbidities, operative time, transfusion requirements, hospital length of stay (LOS), wound infection, haematoma and reoperation rate between the two groups was undertaken. Regression analysis was undertaken to ascertain the risk ratios (RR) of complications and transfusion associated with clopidogrel.
    Results: There was no difference with respect to ASA grade, comorbidities (except cardiac comorbidities), pre- and postoperative haemoglobin levels, operation time, age or gender between the two groups. Four and two patients, respectively, required transfusion postoperatively in the CG and NCG (p = 0.37). There was no difference with respect to LOS, wound infection, haematoma or reoperation rate between the two groups postoperatively. The covariate-adjusted RR for complications and transfusion while being on clopidogrel were 0.43 [95% confidence interval (CI) 0.07-2.60] and 3.96 (95% CI 0.40-39.68), respectively.
    Conclusion: Continuing clopidogrel therapy throughout the perioperative period in patients with intracapsular hip fracture is not associated with an increased risk of complications following hip hemiarthroplasty surgery.
    MeSH term(s) Aged ; Aged, 80 and over ; Blood Transfusion/statistics & numerical data ; Clopidogrel ; Comorbidity ; Databases, Factual ; Female ; Hemiarthroplasty ; Hemorrhage/chemically induced ; Hemorrhage/mortality ; Hemorrhage/prevention & control ; Hip Fractures/mortality ; Hip Fractures/surgery ; Humans ; Male ; Platelet Aggregation Inhibitors/administration & dosage ; Platelet Aggregation Inhibitors/adverse effects ; Postoperative Complications/chemically induced ; Postoperative Complications/mortality ; Postoperative Complications/prevention & control ; Retrospective Studies ; Risk Factors ; Ticlopidine/administration & dosage ; Ticlopidine/adverse effects ; Ticlopidine/analogs & derivatives ; Treatment Outcome
    Chemical Substances Platelet Aggregation Inhibitors ; Clopidogrel (A74586SNO7) ; Ticlopidine (OM90ZUW7M1)
    Language English
    Publishing date 2013-04-06
    Publishing country Italy
    Document type Journal Article
    ZDB-ID 2043336-0
    ISSN 1590-9999 ; 1590-9921
    ISSN (online) 1590-9999
    ISSN 1590-9921
    DOI 10.1007/s10195-013-0235-1
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    Zs.A 6153: Show issues Location:
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  8. Article ; Online: Factors influencing foundation programme choice among medical students.

    Patel, Shelain / Colaco, Henry B / Hossain, Fahad S

    JRSM short reports

    2010  Volume 1, Issue 1, Page(s) 4

    Abstract: Objectives: The advent of Modernising Medical Careers has replaced the traditional pre-registration house officer (PRHO) year and first year of senior house officer (SHO) training with a combined foundation programme. The aim of this study was to find ... ...

    Abstract Objectives: The advent of Modernising Medical Careers has replaced the traditional pre-registration house officer (PRHO) year and first year of senior house officer (SHO) training with a combined foundation programme. The aim of this study was to find out the factors influencing choice of foundation programme among medical students.
    Design: Prospective survey.
    Setting: Three medical schools based in England.
    Main outcome measures: A questionnaire was formulated containing the reasons for choosing a foundation programme with students asked to rank their choices.
    Results: There were 46 replies. The most important factors identified were geographical location (score 154) and combination of specialties (score 178). The least important factors was the reputation of consultants (score 525) and opportunities for research (score 530).
    Conclusions: The factors influencing choice of foundation programme are not dissimilar to the choice of PRHO year despite the different emphasis in training which it offers.
    Language English
    Publishing date 2010-06-30
    Publishing country England
    Document type Journal Article
    ZDB-ID 2563002-7
    ISSN 2042-5333 ; 2042-5333
    ISSN (online) 2042-5333
    ISSN 2042-5333
    DOI 10.1258/shorts.2009.100056
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  9. Article ; Online: Primary gastric Hodgkin's lymphoma

    Koak Yashwant / Hossain Fahad S / Khan Farrukh H

    World Journal of Surgical Oncology, Vol 5, Iss 1, p

    2007  Volume 119

    Abstract: Abstract Background Primary Hodgkin's disease of the stomach is an extremely rare entity. Nearly all cases of primary gastric lymphoma are of the non-Hodgkin's variety. Diagnoses in such cases are difficult due to considerable histological similarities ... ...

    Abstract Abstract Background Primary Hodgkin's disease of the stomach is an extremely rare entity. Nearly all cases of primary gastric lymphoma are of the non-Hodgkin's variety. Diagnoses in such cases are difficult due to considerable histological similarities between the 2 disease entities. Case presentation We report the case of a 77 year old lady with a 1 year history of weight loss and poor appetite. Physical examination was unremarkable. Subsequent multiple upper GI endoscopies revealed a large malignant looking ulcer which was deemed to be histologically benign. Following CT imaging the patient underwent a radical gastrectomy. Postoperatively histology and immunohistochemistry failed to confirm a diagnosis. As such a second opinion was sought. Employing an extended array of immunohistological staining a diagnosis of 'Classical Hodgkin's' disease of the stomach was achieved. Conclusion Our case illustrates the significant difficulties in achieving a rare diagnosis of primary Hodgkin's lymphoma of the stomach. The non-specific nature of symptoms and a lack of histological features make a preoperative diagnosis extremely difficult. While immunohistochemistry is widely employed in aiding the evaluation of such cases, one should be wary of the considerable overlap in differentiating between Hodgkin's and non-Hodgkin's disease entities using this technique.
    Keywords Neoplasms. Tumors. Oncology. Including cancer and carcinogens ; RC254-282 ; Internal medicine ; RC31-1245 ; Medicine ; R ; DOAJ:Oncology ; DOAJ:Medicine (General) ; DOAJ:Health Sciences
    Subject code 610
    Language English
    Publishing date 2007-10-01T00:00:00Z
    Publisher BioMed Central
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  10. Article: Working hours in surgery: the junior's perspective.

    Patel, Shelain / Hossain, Fahad S / Colaco, Henry

    British journal of hospital medicine (London, England : 2005)

    2009  Volume 70, Issue 3, Page(s) M44–5

    MeSH term(s) European Union ; Humans ; Medical Staff, Hospital ; Personnel Staffing and Scheduling/legislation & jurisprudence ; Personnel Staffing and Scheduling/organization & administration ; Work Schedule Tolerance ; Workload/legislation & jurisprudence
    Language English
    Publishing date 2009-03
    Publishing country England
    Document type Journal Article
    ISSN 1750-8460
    ISSN 1750-8460
    DOI 10.12968/hmed.2009.70.Sup3.40584
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