458 Patient Willingness to Undergo Elective Orthopaedic Surgery in Relation to the COVID-19 Outbreak

Objective

To determine patients’ willingness to undergo elective orthopaedic surgery during the COVID-19 pandemic.

Method

4 groups of patients were chosen based on type of surgery. A telephone survey was conducted, including questions on diagnosis, symptom duration, pain severity, co-morbidities, anxiety levels for COVID-19 and surgery. Patients were given the conditions for surgery and asked whether they would undergo surgery, have the operation carried out by another consultant and any factors that would increase their confidence.

Results

Of 200 patients, 156 participated (78%). 78.2% were willing to undergo surgery. There was a statistically significant difference in willingness between age groups 40-49 (100%) and 80 + (58.3%). Differences in willingness between surgery types, BOA risk class, sex, symptom duration and pain scores, were not statistically significant.

Patients unwilling to undergo surgery reported statistically higher anxiety scores for health (4.39) and surgery (4.62) compared to the willing group (2.89 and 2.71 respectively). Patients’ main concern was contracting COVID (35.2%).

Conclusions

Our study demonstrated that the majority of patients were willing to undergo surgery. This can be used to inform strategies for resuming elective surgeries. It has also highlighted several areas in patient perception that warrant further investigation and the importance of enhanced consent on the specific risks.

Neuropeptide Y induced feeding in the rat is mediated by a novel receptor

There are now six recognized neuropeptide Y (NPY) receptor subtypes (Y1-Y4 and two recently cloned distinct receptors labeled Y5), of which Y1 and one of the Y5's have been suggested could mediate the effect of NPY on feeding. The fragments NPY(2-36) and NPY(3-36), which bind Y1 only poorly, were injected intracerebroventricularly (icv) and found to have similar dose-response relationships to NPY in the stimulation of feeding. However NPY (13-36), which stimulates both Y2 and Y5, caused no increase in food intake, even at high doses. Maximal stimulation with the classical Y1 agonist [Pro34]-NPY produced only 50% of the maximum effect of NPY itself despite fully inhibiting adenylyl cyclase activity in vitro in a Y1 system. The novel fragment [Pro34]-NPY(3-36) is as effective at stimulating food intake as the classical Y1 analogue [Pro34]-NPY but bound to the Y1 receptor with only 1/20th of the affinity of NPY and failed to inhibit adenylyl cyclase through this receptor. [Pro34]-NPY(3-36) is therefore a relatively appetite-selective ligand. Coadministration of high dose NPY(13-36) and [Pro34]NPY did not enhance feeding compared with [Pro34]-NPY alone. In addition, the NPY Y1 receptor antagonist BIBP-3226, which does not bind Y2, Y4, or Y5 receptors, significantly reduced NPY induced feeding. These results indicate that the feeding effect of icv NPY involves a novel receptor and that it is functionally distinct from the recognized receptor subtypes.