Muaaz Tahir

Introduction: Orthopaedic training has undergone considerable changes in the last few decades. Although structured training pathways exist in most countries, the requirements for completion of training are remarkably different. This review aims to assess key differences among orthopaedic curricula in selected high-income countries with well-established orthopaedic training programmes, focusing on their criteria for assessing technical competence prior to completion of training. Methods: Current orthopaedic training curricula published by the relevant accrediting bodies in the UK, USA, Canada, Australia, Germany and the European Union were reviewed. Data extracted included specified training duration, minimum or desirable operative experience requirements, methods and timing of in-training assessments. Results: The overall training duration ranged between 9 and 10 years in the UK and Australia, compared to 5–6 years in all other countries. While operative logbook was an essential component of formative and end-of-training reviews in all countries, minimum indicative numbers in index operations were a requirement only in the UK (minimum total required; 1800, index operations; 365) and USA (minimum total required; 1000, index operations; 455). On average, USA residents performed 1700 procedures compared to German residents performing 730 procedures before completion of training. Conclusion: There is a lack of robust data describing the operative experiences of orthopaedic trainees outside of the UK and USA. UK training is the longest among countries compared in this review and also sets the highest standards in minimum operative experience requirements. Based on the evidence available, surgeons exiting training and entering independent practice in the above countries are not trained to the same minimum standard.

Background: Delirium is a common complication after surgery in the elderly that leads to increased length of stay and other adverse outcomes. The aim of this study was to better understand the exact causes of post-operative delirium in patients undergoing surgery for neck of femur (NOF) fractures.Methods: We performed a prospective cohort study of 381 consecutive patients undergoing surgery for NOF fractures at a single institution. Baseline cognitive status and risk factors were recorded on admission. Post-operative cognitive status was assessed at regular intervals until discharge. Binary logistic regression was performed to identify independent predictors of delirium.Results: Patients who developed post-operative delirium (n = 70) were significantly older (average age 83 vs. 78,p = 0.019) and more likely to be female (79% vs. 67%,p = 0.062) than non-affected patients. The presence of delirium was associated with increased length of stay (13 vs. 10 days,p = 0.001) and 1-year mortality (25.7% vs. 15%p = 0.03). Independent predictors of delirium included age ≥65 years (Odds Ratio = 5.8), presence of anaemia (OR = 2.9), hypoxia (OR = 2.86), cardiac disease (OR = 2.8), Chronic Obstructive Pulmonary Disease (OR = 2.5), new onset electrolyte imbalance (OR = 2.2) and renal failure (OR = 1.9).Conclusion: Overall analysis demonstrated an increased incidence of delirium in older females with greater comorbid conditions. It was also found to be associated with increased morbidity and mortality. We recommend clinicians put greater effort into recognising risk factors of delirium and diagnosing it in a timely manner to mitigate its effects.