# Patient Impact of Surgery Abroad: A Retrospective Qualitative Analysis

## TL;DR

This study finds that emergency orthopedic surgery abroad for Northern Ireland residents leads to high complication rates and communication issues, increasing risks and NHS workload.

## Contribution

The study provides new insights into the risks and challenges of emergency orthopedic surgery abroad, specifically for Northern Ireland patients.

## Key findings

- Emergency orthopedic surgery abroad had a 58% complication rate, nearly three times higher than UK benchmarks.
- Communication barriers and lack of interpreter support were common in non-English-speaking countries.
- Half of the patients in non-English-speaking countries lacked interpreter support, and four felt pressured into surgery.

## Abstract

Background

With increasing international travel, more Northern Ireland (NI) residents are sustaining injuries abroad, sometimes requiring emergency orthopaedic surgery. Upon repatriation, the National Health Service (NHS) must address complications and ensure continuity of care. This study evaluates the experiences and outcomes of NI residents who underwent emergency orthopaedic surgery abroad.

Methods

A retrospective qualitative descriptive study was conducted at Ulster Hospital, Belfast, Northern Ireland, between August 2024 and April 2025. Patients who sustained orthopaedic injuries abroad and received emergency surgery overseas were identified via Virtual Fracture Clinic (VFC) records. Data were collected through structured online surveys and analysed descriptively.

Results

Twelve patients were included (median age 62.5 years; nine female, three male). Procedures included open reduction and internal fixation (ORIF) (n = 8), intramedullary (IM) nail (n = 3), and total shoulder arthroplasty (TSA) (n = 1). Postoperative complications occurred in seven patients (58%), including infection, non-union, hardware failure, and the need for revision surgery. Communication barriers were common: two patients did not sign consent forms, and half of those in non-English-speaking countries lacked interpreter support. Four patients felt pressured into surgery abroad, and six (50%) would have preferred repatriation to NI for treatment.

Discussion

Overseas surgery was associated with a high complication rate, substantially exceeding that reported for similar procedures in the UK (10%-20%). Contributing factors included inadequate consent, poor communication, limited postoperative documentation, and lack of structured discharge planning. These findings indicate that emergency surgery abroad frequently compromises patient safety and increases the NHS resource burden.

Conclusion

Emergency orthopaedic surgery abroad carries significant risks, with complications nearly three times higher than UK benchmarks. Improvements in international communication, interpreter availability, and repatriation protocols are urgently needed. NHS policy should anticipate the rising demand for coordinated, cross-border care.