Iain Moppett
@iainmoppett.bsky.social
Human, doctor, anaesthetist, academic - in that order. Director Centre for Research & Improvement at RCoA. Editor Anaesthesia. #HipFracture #AnSky #PatientSafety Views own. Work for University of Nottingham and Nottingham University Hospitals.
‘Anaesthesia was the most frequent provider (36% of cases) but also with delivery by proceduralists and on wards (Fig. 5b).’ Without knowing the context of frequency of LA use (especially with potential for higher doses) difficult to ascribe any concept of relative risk #AnSky
November 18, 2025 at 9:32 AM
‘Anaesthesia was the most frequent provider (36% of cases) but also with delivery by proceduralists and on wards (Fig. 5b).’ Without knowing the context of frequency of LA use (especially with potential for higher doses) difficult to ascribe any concept of relative risk #AnSky
ALLEGRO trial reported lack of benefit on GI function in minimally invasive surgery. #AnSky pubmed.ncbi.nlm.nih.gov/39602290/
October 8, 2025 at 6:17 AM
ALLEGRO trial reported lack of benefit on GI function in minimally invasive surgery. #AnSky pubmed.ncbi.nlm.nih.gov/39602290/
Given this variation in the number of people receiving non-operative management there is an opportunity for international networks such as the Fragility Fracture Network to put some markers down on principles to be followed. If you want to help follow the link.
redcap.mq.edu.au/surveys/?s=X...
redcap.mq.edu.au/surveys/?s=X...
October 2, 2025 at 11:33 PM
Given this variation in the number of people receiving non-operative management there is an opportunity for international networks such as the Fragility Fracture Network to put some markers down on principles to be followed. If you want to help follow the link.
redcap.mq.edu.au/surveys/?s=X...
redcap.mq.edu.au/surveys/?s=X...
Hanna Willems and her colleagues have done some pioneering work in the Netherlands looking at the quality of life – and dying – in people living with marked frailty who chose not to have surgery. pubmed.ncbi.nlm.nih.gov/35234817/
October 2, 2025 at 11:33 PM
Hanna Willems and her colleagues have done some pioneering work in the Netherlands looking at the quality of life – and dying – in people living with marked frailty who chose not to have surgery. pubmed.ncbi.nlm.nih.gov/35234817/
Antony Johansen (of NHFD fame) demonstrated nicely that the daily risk of dying in the early post-operative period is low – even for the highest risk patients.
October 2, 2025 at 11:33 PM
Antony Johansen (of NHFD fame) demonstrated nicely that the daily risk of dying in the early post-operative period is low – even for the highest risk patients.
This is important when thinking about non-operative management. A significant number of people survive for a relatively unpredictable length of time. Around 80% of people at one month and 50% at one year.
October 2, 2025 at 11:33 PM
This is important when thinking about non-operative management. A significant number of people survive for a relatively unpredictable length of time. Around 80% of people at one month and 50% at one year.
Outcomes data are dominated by mortality. Risk of dying at all time points is greater in those having non-operative management of hip fracture. Partly patient selection, and the consequence of not operating and optimising symptom control over prolongation of the dying process.
October 2, 2025 at 11:33 PM
Outcomes data are dominated by mortality. Risk of dying at all time points is greater in those having non-operative management of hip fracture. Partly patient selection, and the consequence of not operating and optimising symptom control over prolongation of the dying process.
Variation in rates of surgery for #HipFracture are NOT fully explained by patient characteristics. The presence of dementia, cancer and higher ASA physical status (greater impact of comorbidities) are associated with non-op management. Something else is going on.
October 2, 2025 at 11:33 PM
Variation in rates of surgery for #HipFracture are NOT fully explained by patient characteristics. The presence of dementia, cancer and higher ASA physical status (greater impact of comorbidities) are associated with non-op management. Something else is going on.
Bear in mind that in many parts of the world people may not even get to hospital with their #HipFracture. Many cultural, social and economic reasons for this as highlighted by Irewin Tabu from the Philippines.
October 2, 2025 at 11:33 PM
Bear in mind that in many parts of the world people may not even get to hospital with their #HipFracture. Many cultural, social and economic reasons for this as highlighted by Irewin Tabu from the Philippines.
Overall, around 1 in 12 patients who get to hospital don’t have surgery for their broken hip – but there is a lot of intra-country and inter-regional variation
October 2, 2025 at 11:33 PM
Overall, around 1 in 12 patients who get to hospital don’t have surgery for their broken hip – but there is a lot of intra-country and inter-regional variation
Internationally, data are sparse – overrepresentation of higher income countries – both for who get an operation for #HipFracture and for important outcomes afterwards
October 2, 2025 at 11:33 PM
Internationally, data are sparse – overrepresentation of higher income countries – both for who get an operation for #HipFracture and for important outcomes afterwards
Although there were concerns about femoral or fascia iliaca nerve blocks affecting mobilisation postop this doesn’t appear to be an issue in practice. Data from the UK Physiotherapy Hip Sprint Audit doesn’t mention nerve blocks as a barrier - but pain is. www.fffap.org.uk/FFFAP/landin...
August 5, 2025 at 7:57 AM
Although there were concerns about femoral or fascia iliaca nerve blocks affecting mobilisation postop this doesn’t appear to be an issue in practice. Data from the UK Physiotherapy Hip Sprint Audit doesn’t mention nerve blocks as a barrier - but pain is. www.fffap.org.uk/FFFAP/landin...
I suspect UK anaesthetists and surgeons might have given different answers. Recorded intraoperative PNB use for hip fracture is over 50% according to www.nhfd.co.uk
August 5, 2025 at 7:57 AM
I suspect UK anaesthetists and surgeons might have given different answers. Recorded intraoperative PNB use for hip fracture is over 50% according to www.nhfd.co.uk
Here’s the delirium princess herself Abi Noah PhD. Beyond delighted to see her graduating today @uniofnottingham.bsky.social
July 23, 2025 at 6:50 PM
Here’s the delirium princess herself Abi Noah PhD. Beyond delighted to see her graduating today @uniofnottingham.bsky.social
Super proud to support @claireswarbrick.bsky.social graduating as PhD @uniofnottingham.bsky.social today. @rcoa-cri.bsky.social #SNAP3
July 23, 2025 at 6:46 PM
Super proud to support @claireswarbrick.bsky.social graduating as PhD @uniofnottingham.bsky.social today. @rcoa-cri.bsky.social #SNAP3
POP-I @pop-i.bsky.social Looking back we’ve travelled a long way 772 participants so far. Looking forward we have a fair way to go. 1628 to reach our target of 2400. @nihr.bsky.social
June 9, 2025 at 9:50 AM
POP-I @pop-i.bsky.social Looking back we’ve travelled a long way 772 participants so far. Looking forward we have a fair way to go. 1628 to reach our target of 2400. @nihr.bsky.social
National @pop-i.bsky.social POP-I meeting. Fantastic opportunity to meet our research teams from across the country. @nihr.bsky.social
June 9, 2025 at 9:44 AM
National @pop-i.bsky.social POP-I meeting. Fantastic opportunity to meet our research teams from across the country. @nihr.bsky.social
Interesting study presented at Orthopaedic Trauma Trials today by David Metcalfe. CESER: Observational study of patients presenting to ED with ?Cauda Equina Syndrome Contact details in slide alt text @rcem.ac.uk @drlindadykes.bsky.social
June 4, 2025 at 4:14 PM
Interesting study presented at Orthopaedic Trauma Trials today by David Metcalfe. CESER: Observational study of patients presenting to ED with ?Cauda Equina Syndrome Contact details in slide alt text @rcem.ac.uk @drlindadykes.bsky.social
SNAP3 I can't list every collaborator but I can show them😀 Can you spot your name? Royal Gwent to University Hospital of North Durham... #AnSky
June 3, 2025 at 6:51 PM
SNAP3 I can't list every collaborator but I can show them😀 Can you spot your name? Royal Gwent to University Hospital of North Durham... #AnSky
SNAP3 Message 2d: The risks of postoperative mortality increase at all time points to one-year (you’ll have to wait a bit for the longer-term data sorry). No prizes for correctly guessing that the risk starts to increase from CFS4 (living with very mild frailty). #AnSky #GeriSky #SurgSky
June 3, 2025 at 6:24 PM
