Acceptance type: Oral 24 Anterior Cruciate Ligament (ACL) and Medial Patellofemoral Ligament Reconstruction (MPFL): Developing a day case pathway

Introduction: ACL and MPFL reconstructions are commonly viewed as day case procedures in the adult sector. However, our experience at a tertiary paediatrics hospital is that very few of these operations are done as day cases. We wanted to explore why we were failing to get patients done as day cases and how we could improve this. Methods: We performed a retrospective audit looking at all ACL and MPFL reconstructions performed from January 2019 to March 2020 Results: 63 ligament reconstructions were performed at our hospital during the above time period. Only 9 (14%) patients were discharged on the same day as their operation. Whilst our average length of stay was 1.34 days, 26 patients (41%) had their operations on afternoon lists and none of them went home the same day. Nearly all patients (97%) had either a femoral or adductor canal block and, whilst there were comparable pain scores (femoral 2.23, adductor canal 2.56), the femoral nerve block precipitated significantly more leg weakness (37% vs 4.5%) which inhibited engagement with physio in the post-op period. We found no benefit in pain scores from the use of intra-operative morphine (2.38 vs 2.41) and only a mild benefit from clonidine (1.94 vs 2.64). Conclusion: Our work demonstrates that paediatric ligament reconstructions can be performed as day case procedures. We recommend that day case pathways for patients in this context should include placement on a morning list, administration of intra-operative adductor canal blocks and a multi-model approach to analgesia that avoids opiates. 46 Early Experience of Primary Transurethral water vapour treatment (Rezum®) for symptomatic Benign Prostatic Hyperplasia: an analysis of 332 consecutive patients Nimlan Shanmugathas, Christopher Khoo, Martin Connor, David Eldred-Evans, Carmen Lok Tung Ho, Arsam Mahmood, Soroush Nokhodchi, Andrew Ser Jien Ting, Amar Rai, Feargus Hosking-Jervis, Deepika Reddy, Mariana Bertoncelli Tanaka, Taimur T Shah, Arnas Rakauskas, Mathias Winkler, Sanjiv Agarwal, Taimur El-Husseiny, Hashim Ahmed Imperial College NHS Foundation Trust, London, United Kingdom Abstract Introduction: Transurethral water vapour treatment (Rezum®) is a novel minimallyinvasive therapy for lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH). We report early functional outcomes and adverse events. Methods: Retrospective analysis of 332 consecutive patients at two centres between Aug/2017-Nov/2019. Inclusion criteria: LUTS secondary to BPH (pVol<120cc), acute urinary retention (failed TWOC), long-term catheter in-situ, absence of clinically significant prostate cancer and no prior BPH treatment. Results: Median age was 69yrs (IQR 62-74) and median pVol 53cc (IQR 41-70) with 20.8% (69/332) >80cc. Pre-operatively, 66.9% (222/332) used α-blockers, with 42.7% (99/332) using 5α-reductase inhibitors. 99.0% (329/332) procedures were successfully completed. General anaesthesia, sedation and local anaesthetic were used in 81.3% (270/332), 18.4% (61/332) and 0.3% (1/332), respectively. Median operative duration was 9 minutes (IQR 7–12). There was successful 1st TWOC in 72.9% (242/332) a median 7 days post-operatively. 96.4% (320/332) achieved same-day discharge. Clavien-Dindo complications grade >/=2 occurred in 1.8% (6/332). 1.5% (5/332) were re-admitted for post-operative haematuria; none required blood product transfusion. In patients with paired outcomes, mean baseline IPSS was 22.7 (SD 6.6) and at 3-months 7.42 (SD 5.8) (change -15.3 (-67.4%)). Mean baseline QMax was 10.6 ml/s (SD 5.9) and at 3-months 17.4 ml/s (SD 8.1); (change +6.8 ml/s (+64.3%)). Further BPH surgery was performed for refractory symptoms in 1.8% (6/332). Conclusion: Early outcomes for primary Rezum® demonstrate few serious adverse events and promising improvements in LUTS. Further prospective long-term and comparative evaluation will determine validity of these findings.Introduction: Transurethral water vapour treatment (Rezum®) is a novel minimallyinvasive therapy for lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH). We report early functional outcomes and adverse events. Methods: Retrospective analysis of 332 consecutive patients at two centres between Aug/2017-Nov/2019. Inclusion criteria: LUTS secondary to BPH (pVol<120cc), acute urinary retention (failed TWOC), long-term catheter in-situ, absence of clinically significant prostate cancer and no prior BPH treatment. Results: Median age was 69yrs (IQR 62-74) and median pVol 53cc (IQR 41-70) with 20.8% (69/332) >80cc. Pre-operatively, 66.9% (222/332) used α-blockers, with 42.7% (99/332) using 5α-reductase inhibitors. 99.0% (329/332) procedures were successfully completed. General anaesthesia, sedation and local anaesthetic were used in 81.3% (270/332), 18.4% (61/332) and 0.3% (1/332), respectively. Median operative duration was 9 minutes (IQR 7–12). There was successful 1st TWOC in 72.9% (242/332) a median 7 days post-operatively. 96.4% (320/332) achieved same-day discharge. Clavien-Dindo complications grade >/=2 occurred in 1.8% (6/332). 1.5% (5/332) were re-admitted for post-operative haematuria; none required blood product transfusion. In patients with paired outcomes, mean baseline IPSS was 22.7 (SD 6.6) and at 3-months 7.42 (SD 5.8) (change -15.3 (-67.4%)). Mean baseline QMax was 10.6 ml/s (SD 5.9) and at 3-months 17.4 ml/s (SD 8.1); (change +6.8 ml/s (+64.3%)). Further BPH surgery was performed for refractory symptoms in 1.8% (6/332). Conclusion: Early outcomes for primary Rezum® demonstrate few serious adverse events and promising improvements in LUTS. Further prospective long-term and comparative evaluation will determine validity of these findings. 55 Introducing Day Case Arthroplasty at a District General Hospital During the Coronavirus Pandemic Alireza Esfandiari, Rami Ashour Countess of Chester Hospital, Chester, United Kingdom Abstract Introduction: Day case arthroplasty has gained increased traction in recent years, freeing up hospital beds and reducing healthcare costs whilst maintaining excellent outcomes. The Coronavirus pandemic has forced a rethink of elective surgery in order to minimise inpatient stays and address the backlog of patients on waiting lists. Our aim has been to facilitate the restart of lower limb arthroplasty surgery during the pandemic by introducing day case surgery at our average-sized district general hospital. Methods: Criteria were outlined to identify patients that may be suitable for day case arthroplasty surgery. Appropriate patients were counselled in the outpatient clinic, given preoperative instructions and listed accordingly. Preoperative narcotics were ceased, and patients commenced on anti-inflammatories, neuropathic analgesia and highcalorie drinks two days prior to admission. Patients were discharged on a predetermined analgesic combination based on their bodyweight. Followup was made by telephone the same night and later in the week, and in person at 6 weeks. Results: Between October and December 2020, all total hip replacements (THR) that were planned as day cases went ahead successfully, representing 54% of THR cases and 37.5% of all joint replacements performed by the senior author. Total length of stay ranged from 9 to 12 hours. There were no readmissions, good pain control and excellent patient satisfaction. No patients contracted Coronavirus during their hospital journey. Conclusions: Our experience of introducing day case surgery at our hospital has thus far been successful and will be expanding to include total knee replacements in the near future.Introduction: Day case arthroplasty has gained increased traction in recent years, freeing up hospital beds and reducing healthcare costs whilst maintaining excellent outcomes. The Coronavirus pandemic has forced a rethink of elective surgery in order to minimise inpatient stays and address the backlog of patients on waiting lists. Our aim has been to facilitate the restart of lower limb arthroplasty surgery during the pandemic by introducing day case surgery at our average-sized district general hospital. Methods: Criteria were outlined to identify patients that may be suitable for day case arthroplasty surgery. Appropriate patients were counselled in the outpatient clinic, given preoperative instructions and listed accordingly. Preoperative narcotics were ceased, and patients commenced on anti-inflammatories, neuropathic analgesia and highcalorie drinks two days prior to admission. Patients were discharged on a predetermined analgesic combination based on their bodyweight. Followup was made by telephone the same night and later in the week, and in person at 6 weeks. Results: Between October and December 2020, all total hip replacements (THR) that were planned as day cases went ahead successfully, representing 54% of THR cases and 37.5% of all joint replacements performed by the senior author. Total length of stay ranged from 9 to 12 hours. There were no readmissions, good pain control and excellent patient satisfaction. No patients contracted Coronavirus during their hospital journey. Conclusions: Our experience of introducing day case surgery at our hospital has thus far been successful and will be expanding to include total knee replacements in the near future. 58 The Coronavirus Pandemic: A catalyst for the accelerated development of a successful new Orthopaedic service in Glasgow Lindsay Hudman, Colin Drury, Sonya McKinlay Glasgow Royal Infirmary, Glasgow, United Kingdom Abstract Introduction: North Glasgow Orthopaedic services are provided at Glasgow Royal Infirmary (GRI) and New Stobhill Ambulatory Care Hospital (NSH), with arthroplasty predominantly undertaken at GRI (2019, n=586) and selected unicondylar kneeIntroduction: North Glasgow Orthopaedic services are provided at Glasgow Royal Infirmary (GRI) and New Stobhill Ambulatory Care Hospital (NSH), with arthroplasty predominantly undertaken at GRI (2019, n=586) and