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- Talk
- 20/09/2023
- UK
The Perioperative Management of Metastatic Fracture Patients - A Matter of Time?
Description
Rachel Baumber, an anesthetist with a focus on intensive care at the Royal National Orthopedic Hospital, opens her talk with an expression of nervousness as she finds herself speaking to a large audience, contrary to her expectations of a small room. She reassures the audience that her discussion will not delve into technical aspects of anesthetics but rather center around the management of patients with metastatic bone disease, stressing its relevance based on her research findings.
Baumber discusses the current guidelines regarding the urgency of treating such patients, emphasizing that the typical handling time for fragility fractures does not apply. Instead, the guidelines suggest a 72-hour referral period to a specialized center if a primary bone tumor is suspected, and a focus on obtaining necessary staging CTs within 24 hours. She raises a question about the actual time taken for patients to receive definitive surgery after being admitted with fractures related to metastatic lesions, sharing data from her retrospective study over four years.
Throughout her presentation, Baumber provides statistics on patient demographics, referral times, and various delays encountered post-admission, demonstrating that many patients wait significantly longer than the recommended guidelines. She highlights the importance of timely interventions to mitigate complications like muscle deconditioning and increased risk of DVTs during prolonged bed rest.
Baumber also discusses the complexities of managing these patients, particularly emphasizing the need for a proactive multidisciplinary team (MDT) approach that includes oncologists and palliative care specialists early in the treatment process. She calls for a collaborative effort to refine best practices and guidelines in managing metastatic fractures, suggesting that surgeons should aim to perform operations within two weeks of injury to optimize outcomes and facilitate rehabilitation.
In conclusion, Baumber appeals for more data collection and research, advocating for a concerted effort to address the growing needs of this patient population, and invites discussions on optimizing care strategies to improve patient experiences and outcomes.