1046 Anterior Lumbar Interbody Fusion Approaches: A Systematic Review

Aim

Anterior lumbar interbody fusion (ALIF) is a well-established alternative to posterior-based interbody fusion techniques, with approach variations, such as retroperitoneal; transperitoneal; open; and laparoscopic well described. Variable rates of complications for each approach have been enumerated in the literature. We aim to elucidate the comparative rates of complications across approach type.

Method

A systematic review of the search databases Pubmed; google scholar; and OVID Medline was made in November 2020 to identify studies related to complications associated with anterior lumbar interbody fusion. PRISMA guidelines were utilised for this review. Studies eligible for inclusion were agreed by two independent reviewers. Meta-analysis was used to compare intra- and postoperative complications with ALIF for each approach.

Results

4575 studies were identified, with 5728 patients across 31 studies included for review following application of inclusion and exclusion criteria. Meta-analysis demonstrated the transperitoneal approach resulted in higher rates of Retrograde Ejaculation (RE) (p < 0.001; CI = 0.05-0.21) and overall rates of complications (p = 0.05; CI = 0.00-0.23). Rates of RE were higher at the L5/S1 intervertebral level. Rates of vessel injury were not significantly higher in either approach method (p = 0.89; CI=-0.04-0.07). Laparoscopic approaches resulted in shorter inpatient stays (p = 0.01).

Conclusions

Despite the transperitoneal approach being comparatively underpowered, its use appears to result in a significantly higher rate of intra- and postoperative complications, although confounders including use of BMP and spinal level should be considered. Laparoscopic approaches resulted in shorter hospital stays, however its steep learning curve and longer operative time have deterred surgeons from its widespread adaptation.

1044 Impact of Obesity on Complications from Anterior Lumbar Interbody Fusion

Aim

Anterior Lumbar Interbody Fusion is a procedure growing in popularity for conditions including degenerative disc disease, and discogenic back pain. Obesity is a significant risk factor in the development of back pain, with patients with raised BMIs at increased of complications using the posterior approach. This review aims to evaluate the risk profile of this patient cohort using the anterior approach for lumbar interbody fusion.

Method

A systematic review of the search databases Pubmed; google scholar; and OVID Medline was carried out between September 2020-November 2020. Studies evaluating the risks associated with obesity during Anterior Lumbar Interbody Fusion (ALIF) were identified and included for review according to PRISMA guidelines. Studies eligible for inclusion were agreed by two independent reviewers. Meta-analysis was used to compare intra- and postoperative complications in patients with increased BMI during ALIF.

Results

Search terms yielded 435 articles for evaluation. 13 studies were included in this review after applying inclusion and exclusion criteria. Meta-analysis of studies demonstrated a significantly increased risk profile for overall complications in the obese patient cohort (CI = 0.04-0.16, p = 0.002) with significant heterogeneity (I2=86%). Patients with increased BMI were not significantly more likely to develop Vascular complications (CI= -.03-0.02, p = 0.62). Simple pooling demonstrated significant association between increased BMI and blood loss.

Conclusions

Obesity was demonstrated to have an impact on overall complication rates in Anterior Lumbar Interbody Fusion procedures, with postoperative complications including wound infections and lower fusion rates more common in patients in increased BMIs.

995 Bedside Teaching from A Distance; Surgical Education in The COVID Era

Introduction

The COVID pandemic resulted in a shutdown of facilities and resources globally. With drastic changes in the provision of services available in the health sector, so too were medical students’ provision of learning. With the onslaught of COVID and the need for ongoing learning resources for students, novel methods to maintain adequate surgical patient exposure and student interaction on a platform amenable to the interactive format required was devised using a virtual platform to compliment current pedagogical approaches.

Method

This was a randomised control trial to evaluate the perceived use of remote learning in place of surgical bedside teaching in the COVID-19 era. Medical students in a regional hospital were recruited and randomised to undergo the bedside teaching in person or receive the teaching virtually through a Xpert eye, smart glasses to facilitate connections remotely. Feedback questionnaires and exit interviews carried out following each session. Content analysis of transcripts was performed to evaluate the presence and quality of perceived learning, benefits, and limitations.

Results

Feedback demonstrated greater engagement, satisfaction, involvement, and learning (p < 0.01) in the bedside teaching group. Content analysis yielded three main themes: Interpersonal content, technological features, and provision of content. Students reported the virtual teaching was an acceptable alternative in the current climate of social distancing and reduced patient access.

Conclusions

The current pandemic poses a risk to adequate patient exposure to patient centred learning. Teaching sessions received remotely are an acceptable alternative in the current climate of reduced clinical access, however bedside teaching remains the preferred method of learning.

1005 Acquisition of Surgical Skills in Medical Students Via Telementoring: A Randomised Control Trial

Aim

To evaluate the use of telementoring in acquisition of basic suturing skills in medical students.

Method

This was a single blinded two- armed randomised control trial. Medical students undergoing clinical rotations in their penultimate and final years were invited to participate in this study. Informed consent was obtained. The control group underwent conventional suturing training, with the interventional group undergoing the tutorial in a remote learning setting via live streaming. Pre- and post-test assessment was carried out using validated Global Rating Scale tool.

Results

Eleven students were enrolled in this study. Participants were comparable at baseline (p=.18) and following the tutorial (p=.29). Participants improved to a statistically significant degree in both the virtual group (p=.02) and the in-person group (p=.001).

Conclusions

Telementoring is an effective tool in the provision of teaching basic suturing skills in medical students. Research on its use in more complex practical skills is warranted.

1006 Impact of The Human Factor on Student Interest in Orthopaedic Surgery: A Randomised Control Trial

Aim

The positive learning experiences of students on surgical rotations which subsequently influence career choice may be delineated into practical and interpersonal themed factors. It remains unclear the relative impact each component has on the student experience and subsequent specialisation. We evaluated the influence of having senior resident mentor during practical simulation in orthopaedic surgery has on medical student interest in surgery; their comfort in theatre; and its role in enhancing knowledge acquisition within the rotation

Method

Medical students undergoing clinical rotations in a Regional University Hospital were randomised to undertaking a a virtual reality simulated operation independently or performing under the guidance of an experienced resident. Baseline levels of interest in surgery, comfort in theatre, perceived barriers to surgical learning and entry to surgery were established and compared to answers following completion of the tutorial. Qualitative feedback was collected regarding the benefits and limitations to the experience. Presented according to CONSORT guidelines.

Results

Participants in the resident guided group achieved significantly higher simulated performance scores compared to the control (p < 0001), with an increase in orthopaedic surgery from baseline expressed to a statistically significant degree (p = 0.04). 100% participants strongly agreed it was a beneficial learning experience which would be useful in surgical curricula.

Conclusions

Surgical trainee guided simulation led to improved performance and interest in orthopaedic surgery, while virtual practical experience was felt to be a useful learning tool independent of supervision. Further research is needed to establish the role of interpersonal interactions in student surgical experience.

572 Virtual Reality Operative Simulation in Orthopaedic Surgical Training During Periods of Restricted Clinical Hours: Systematic Review

Introduction

The public health response to the coronavirus pandemic-imposed limitations upon orthopaedic surgeon’s scheduled care practice, with a consequential diminution of training time for residents. A potentially viable option for maintenance of operative competency is the use of virtual reality (VR) simulation. This review looks at the effectiveness of (VR) as a pedagogical method of learning for orthopaedic trainees.

Question

Can VR be a viable method of learning and skill retention for orthopaedic trainees during periods of diminished operative time?

Method

A systematic search using Google Scholar, EMBASE and PubMed was conducted in July 2020.

Results

Following the PRIMSA guidelines; initial search revealed 779 studies. 35 full text articles were analysed by two reviewers with a final total of 30 articles used in this review. A thematic analysis revealed three broad categories: quality and validity of VR teaching simulations studies (n = 8); learning curves and subject performance (n = 14) and VR simulators utility in orthopaedics reviews (n = 8).

Conclusions

We demonstrated that VR has the capacity to help trainees maintain their technical skills, enhance their precision, and retain rudimentary competency during this pandemic. Additional improvements are necessary to ensure its safety as a training tool.

406 Bioabsorbable Screws in Scaphoid Fractures; a systematic review

Background

Scaphoid fractures account for 90% carpal injury. Due to the limited vascular supply achieving adequate reduction and healing is important to avoid complications including avascular necrosis. Recent technological advances have led to renewed vigour in bioabsorbable material research to develop devices which could be used without the need for removal and complications including stress shielding and suboptimal imaging.

Method

A systematic review was made using PubMed, Ovid Medline, and Google Scholar databases according to PRISMA guidelines.

Results

Initial search results yielded 852 studies. 124 studies were screened, resulting in 7 studies which were included in this review. The level of evidence of studies ranged between III-IV of low power. Analysis demonstrated mixed findings with generally comparable outcomes to traditionally used screws. Heterogeneity of studies prevented a meta-analysis.

Conclusions

Development in bioabsorbable materials has yielded promising results in orthopaedic studies, however there is a dearth in research using these devices in the scaphoid. Further robust research is needed to establish the efficacy and applicability of bioabsorbable devices in the scaphoid bone.

Foot and ankle service adaptation in response to COVID-19 and beyond

The disruption to healthcare provision as a result of the COVID-19 pandemic has compelled us to streamline healthcare delivery. This has given us an opportunity to implement healthcare technology, reform inter-disciplinary collaboration and ultimately enhance patient care. We discuss some of the advances made by the foot and ankle department at our hospital. These innovations have broad applicability and will hopefully ignite discussion amoung a number of healthcare teams about improving the future care of their patients.