The orthopaedic waiting list crisis

Aims Due to widespread cancellations in elective orthopaedic procedures, the number of patients on waiting list for surgery is rising. We aim to determine and quantify if disparities exist between inpatient and day-case orthopaedic waiting list numbers; we also aim to determine if there is a ‘hidden burden’ that already exists due to reductions in elective secondary care referrals. Methods Retrospective data were collected between 1 April 2020 and 31 December 2020 and compared with the same nine-month period the previous year. Data collected included surgeries performed (day-case vs inpatient), number of patients currently on the orthopaedic waiting list (day-case vs inpatient), and number of new patient referrals from primary care and therapy services. Results There was a 52.8% reduction in our elective surgical workload in 2020. The majority of surgeries performed in 2020 were day case surgeries (739; 86.6%) with 47.2% of these performed in the independent sector on a ‘lift and shift’ service. The total number of patients on our waiting lists has risen by 30.1% in just 12 months. As we have been restricted in performing inpatient surgery, the inpatient waiting lists have risen by 73.2%, compared to a 1.6% rise in our day-case waiting list. New patient referral from primary care and therapy services have reduced from 3,357 in 2019 to 1,722 in 2020 (49.7% reduction). Conclusion This study further exposes the increasing number of patients on orthopaedic waiting lists. We observed disparities between inpatient and day-case waiting lists, with dramatic increases in the number of inpatients on the waiting lists. The number of new patient referrals has decreased, and we predict an influx of referrals as the pandemic eases, further adding to the pressure on inpatient waiting lists. Robust planning and allocation of adequate resources is essential to deal with this backlog. Cite this article: Bone Jt Open 2021;2(7):530–534.

A MONTE-CARLO MODEL FOR CAISSON OVERTURNING BY TSUNAMIS

Robust planning, engineering, and design in regions exposed to coastal inundation and wave extremes are critically important for ensuring economic and community resilience. To address this need, the profession is moving toward multi-faceted, risk-based approaches based on probabilistic hazard exposure that account for uncertainty. Herein, a Monte-Carlo model for sliding and overturning of caissons under extreme hydrodynamic loading is presented. The model may be used to support risk-based analyses during caisson design as well as in the characterization of inundation extremes from contemporary hazard reconnaissance and from the geological and archaeological records. Herein, model applications are presented (1) to characterize the 2nd century AD Mediterranean tsunami that damaged the ancient harbor of Caesarea, Israel and (2) to develop a scaling law for overturning.