154 results found
Hagens ERC, Henegouwen MIVB, van Sandick JW, et al., 2019, Distribution of lymph node metastases in esophageal carcinoma [TIGER study]: study protocol of a multinational observational study, BMC CANCER, Vol: 19, ISSN: 1471-2407
Doganay E, Moorthy K, 2019, Prehabilitation for esophagectomy, JOURNAL OF THORACIC DISEASE, Vol: 11, Pages: S632-S638, ISSN: 2072-1439
Scott AJ, Mason SE, Langdon AJ, et al., 2018, Prospective risk factor analysis for the development of post-operative Urinary retention following ambulatory general surgery, World Journal of Surgery, Vol: 42, Pages: 3874-3879, ISSN: 1432-2323
AimsPost-operative urinary retention (POUR) is a common cause of unplanned admission following day-case surgery and has negative effects on both patient and surgical institution. We aimed to prospectively evaluate potential risk factors for the development of POUR following day-case general surgical procedures.MethodsOver a 24-week period, consecutive adult patients undergoing elective day-case general surgery at a single institution were prospectively recruited. Data regarding urinary symptoms, comorbidities, drug history, surgery and perioperative anaesthetic drug use were collected. The primary outcome was the incidence of POUR, defined as an impairment of bladder voiding requiring either urethral catheterisation, unplanned overnight admission or both. Potential risk factors for the development of POUR were analysed by logistic regression.ResultsA total of 458 patients met the inclusion criteria during the study period, and data were collected on 382 (83%) patients (74.3% male). Sixteen patients (4.2%) experienced POUR. Unadjusted analysis demonstrated three significant risk factors for the development of POUR: age ≥ 56 years (OR 7.77 [2.18–27.78], p = 0.002), laparoscopic surgery (OR 3.37 [1.03–12.10], p = 0.044) and glycopyrrolate administration (OR 5.56 [2.00–15.46], p = 0.001). Male sex and lower urinary tract symptoms were not significant factors. Multivariate analysis combining type of surgery, age and glycopyrrolate use revealed that only age ≥ 56 years (OR 8.14 [2.18–30.32], p = 0.0018) and glycopyrrolate administration (OR 3.48 [1.08–11.24], p = 0.0370) were independently associated with POUR.ConclusionsPatients aged at least 56 years and/or requiring glycopyrrolate—often administered during laparoscopic procedures—are at increased risk of POUR following ambulatory general surgery.
Kamocka A, McGlone ER, Pevida BP, et al., 2018, SURGICAL REVISION OF CANDY CANE AFTER ROUX-EN-Y GASTRIC BYPASS, 23rd World Congress of the International-Federation-for-the-Surgery-of-Obesity-and-Metabolic-Disorders (IFSO), Publisher: SPRINGER, Pages: 232-232, ISSN: 0960-8923
Shipway D, Koizia L, Winterkorn N, et al., 2018, Embedded geriatric surgical liaison is associated with reduced inpatient length of stay in older patients admitted for gastrointestinal surgery, Future Healthcare Journal, Vol: 5 (2)
Visser E, van Rossum PSN, van Veer H, et al., 2018, A structured training program for minimally invasive esophagectomy for esophageal cancer-a Delphi consensus study in Europe, DISEASES OF THE ESOPHAGUS, Vol: 31, ISSN: 1120-8694
Markar SR, Naik R, Malietzis G, et al., 2017, Component analysis of enhanced recovery pathways for esophagectomy, Diseases of the Esophagus, Vol: 30, ISSN: 1120-8694
The objective of this systematic review is to identify key components of enhanced recovery protocols (ERP) that lead to improved length of hospital stay (LOS) following esophagectomy. Relevant electronic databases were searched for studies comparing clinical outcome from esophagectomy followed by a conventional pathway versus ERP. Relevant outcome measures were compared and metaregression was performed to identify the key ERP components associated with reduced in LOS. Thirteen publications were included, ERP was associated with no changes in in-hospital mortality, total complications, anastomotic leak, or pulmonary complications compared with a conventional pathway, however LOS was reduced in the ERP group. Metaregression identified that immediate extubation was associated with reduced LOS (OR = −0.51, 95%CI −0.77 to −0.25; P < 0.01). Several postoperative factors were associated with a significant reduction in length of hospital stay, and in order of most important were (i) gastrograffin swallow ≤5 days (OR = −4.27, 95%CI −4.50 to −4.03); (ii) mobilization on postoperative day ≤1 (OR = −2.49, 95%CI −2.63 to −2.34); (iii) removal of urinary catheter ≤2 days (OR = −0.99, 95%CI −1.15 to −0.84); (iv) oral intake with at least sips of fluid ≤1 day (OR = −0.96, 95%CI −1.24 to −0.68); (v) enteral diet with feeding jejunostomy or gastrostomy ≤ 1 day (OR = −0.57, 95%CI −0.80 to −0.35) and (vi) epidural removal ≤ 4 days (OR = −0.17, 95%CI −0.27 to −0.07). Several core ERP components and principles appear to be associated with LOS reduction. These elements should form a part of the core ERP for the specialty, while surgical teams incorporate other elements through an iterative process.
Antonowicz S, Segaran A, Mercer S, et al., 2017, Laparoscopic gastric mobilisation for oesophagectomy: outputs from the 4th oesophagogastric surgical quality improvement alliance, 20th Annual Scientific Meeting of the Association-of-Upper-Gastrointestinal-Surgeons-of-Great-Britain-and-Ireland (AUGIS), Publisher: WILEY, Pages: 44-44, ISSN: 0007-1323
Khoo B, Boshier PR, Freethy A, et al., 2017, Redefining the stress cortisol response to surgery., Clinical Endocrinology, Vol: 87, Pages: 451-458, ISSN: 1365-2265
BACKGROUND: Cortisol levels rise with the physiological stress of surgery. Previous studies have used older, less-specific assays, have not differentiated by severity or only studied procedures of a defined type. The aim of this study was to examine this phenomenon in surgeries of varying severity using a widely used cortisol immunoassay. METHODS: Euadrenal patients undergoing elective surgery were enrolled prospectively. Serum samples were taken at 8 am on surgical day, induction and 1 hour, 2 hour, 4 hour and 8 hour after. Subsequent samples were taken daily at 8 am until postoperative day 5 or hospital discharge. Total cortisol was measured using an Abbott Architect immunoassay, and cortisol-binding globulin (CBG) using a radioimmunoassay. Surgical severity was classified by POSSUM operative severity score. RESULTS: Ninety-three patients underwent surgery: Major/Major+ (n = 37), Moderate (n = 33) and Minor (n = 23). Peak cortisol positively correlated to severity: Major/Major+ median 680 [range 375-1452], Moderate 581 [270-1009] and Minor 574 [272-1066] nmol/L (Kruskal-Wallis test, P = .0031). CBG fell by 23%; the magnitude of the drop positively correlated to severity. CONCLUSIONS: The range in baseline and peak cortisol response to surgery is wide, and peak cortisol levels are lower than previously appreciated. Improvements in surgery, anaesthetic techniques and cortisol assays might explain our observed lower peak cortisols. The criteria for the dynamic testing of cortisol response may need to be reduced to take account of these factors. Our data also support a lower-dose, stratified approach to dosing of steroid replacement in hypoadrenal patients, to minimize the deleterious effects of over-replacement.
Wynter-Blyth V, Moorthy K, 2017, Prehabilitation: preparing patients for surgery., BMJ, Vol: 358, Pages: j3702-j3702
Rogers CA, Reeves BC, Byrne J, et al., 2017, Adaptation of the By-Band randomized clinical trial to By-Band-Sleeve to include a new intervention and maintain relevance of the study to practice., Br J Surg, Vol: 104, Pages: 1207-1214
BACKGROUND: Recruitment into surgical RCTs can be threatened if new interventions available outside the trial compete with those being evaluated. Adapting the trial to include the new intervention may overcome this issue, yet this is not often done in surgery. This paper describes the challenges, rationale and methods for adapting an RCT to include a new intervention. METHODS: The By-Band study was designed in the UK in 2009-2010 to compare the effectiveness of laparoscopic adjustable gastric band and Roux-en-Y gastric bypass for severe obesity. It contained a pilot phase to establish whether recruitment was possible, and the grant proposal specified that an adaptation to include sleeve gastrectomy would be considered if practice changed and recruitment was successful. Information on changing obesity surgery practice, updated evidence and expert opinion about trial design were used to inform the adaptation. RESULTS: The pilot phase recruited over 13 months in 2013-2014 and randomized 80 patients (79 anticipated). During this time, major changes in obesity practice in the UK were observed, with gastric band reducing from 32·6 to 15·8 per cent and sleeve gastrectomy increasing from 9·0 to 28·1 per cent. The evidence base had not changed markedly. The British Obesity and Metabolic Surgery Society and study oversight committees supported an adaptation to include sleeve gastrectomy, and a proposal to do so was approved by the funder. CONCLUSION: Adaptation of a two-group surgical RCT can allow evaluation of a third procedure and maintain relevance of the RCT to practice. It also optimizes the use of existing trial infrastructure to answer an additional important research question. Registration number: ISRCTN00786323 (http://www.isrctn.com/).
Fouad K, Halliday L, Halley M, et al., 2017, Is Onodera's Prognostic Nutritional Index associated with postoperative complications following oesophago-gastric cancer resection?, International Congress of the Association-of-Surgeons-of-Great-Britain-and-Ireland, Publisher: WILEY, Pages: 199-199, ISSN: 0007-1323
Halliday L, Wynter-Blyth V, Moorthy K, 2017, Improving surgical outcomes - applying the principles of incremental gains to the surgical perioperative pathway, International Congress of the Association-of-Surgeons-of-Great-Britain-and-Ireland, Publisher: WILEY, Pages: 66-66, ISSN: 0007-1323
Moorthy K, Wynter-Blyth V, 2017, Prehabilitation in perioperative care, BRITISH JOURNAL OF SURGERY, Vol: 104, Pages: 802-803, ISSN: 0007-1323
Charani E, Tarrant C, Moorthy K, et al., 2017, Understanding antibiotic decision making in surgery-a qualitative analysis., Clinical Microbiology and Infection, Vol: 23, Pages: 752-760, ISSN: 1469-0691
OBJECTIVE: To investigate the characteristics and culture of antibiotic decision making in the surgical specialty. METHODS: A qualitative study including ethnographic observation and face-to-face interviews with participants from six surgical teams at a teaching hospital in London was conducted. Over a 3-month period: (a) 30 ward rounds (WRs) (100 h) were observed, (b) face-to-face follow-up interviews took place with 13 key informants, (c) multidisciplinary meetings on the management of surgical patients and daily practice on wards were observed. Applying these methods provided rich data for characterizing the antibiotic decision making in surgery and enabled cross-validation and triangulation of the findings. Data from the interview transcripts and the observational notes were coded and analysed iteratively until saturation was reached. RESULTS: The surgical team is in a state of constant flux with individuals having to adjust to the context in which they work. The demands placed on the team to be in the operating room, and to address the surgical needs of the patient mean that the responsibility for antibiotic decision making is uncoordinated and diffuse. Antibiotic decision making is considered by surgeons as a secondary task, commonly delegated to junior members of their team and occurs in the context of disjointed communication. CONCLUSION: There is lack of clarity around medical decision making for treating infections in surgical patients. The result is sub-optimal and uncoordinated antimicrobial management. Developing the role of a perioperative clinician may help to improve patient-level outcomes and optimize decision making.
Ahmed A, Tharakan G, Purkayastha S, et al., 2017, The role of increased glycemic variability and glucagon in the pathophysiology of postprandial hypoglycemia after RYGB, 8th Annual Scientific Meeting of the British-Obesity-and-Metabolic-Surgery-Society (BOMSS), Publisher: Wiley, Pages: 13-13, ISSN: 1365-2168
Ahmed A, Tharakan G, Purkayastha S, et al., 2017, Management of post prandial hypoglycaemia using liraglutide - comprehensive profiling pre and post intervention, 8th Annual Scientific Meeting of the British-Obesity-and-Metabolic-Surgery-Society (BOMSS), Publisher: Wiley, Pages: 7-8, ISSN: 1365-2168
Ahmed A, Tharakan G, Purkayastha S, et al., 2017, Bariatric surgery outcomes in the over-60s: a single centre, observational study from 2007-2012, 8th Annual Scientific Meeting of the British-Obesity-and-Metabolic-Surgery-Society (BOMSS), Publisher: Wiley, Pages: 6-6, ISSN: 1365-2168
Tucker O, Peters CJ, Zohra R, et al., 2016, A multicentre prospective observational cohort study to determine factors associated with postoperative pneumonia in patients undergoing oesophago-gastric resections, 19th Annual Scientific Meeting of the Association-of-Upper-Gastrointestinal-Surgeons-of-Great-Britain-and-Ireland, Publisher: Wiley, Pages: 39-39, ISSN: 1365-2168
Halliday L, Mcleland L, Moorthy K, 2016, Compliance with elements of enhanced recovery protocols for oesophago-gastric surgery: drivers for multi-disciplinary collaborative quality improvement, 19th Annual Scientific Meeting of the Association-of-Upper-Gastrointestinal-Surgeons-of-Great-Britain-and-Ireland, Publisher: WILEY-BLACKWELL, Pages: 58-58, ISSN: 0007-1323
Halliday L, Rymarowicz J, Shipway D, et al., 2016, Objective measures of frailty in the elderly with resectable oesophago-gastric cancer are associated with poor post-operative outcomes, 19th Annual Scientific Meeting of the Association-of-Upper-Gastrointestinal-Surgeons-of-Great-Britain-and-Ireland, Publisher: WILEY-BLACKWELL, Pages: 12-12, ISSN: 0007-1323
McKinnon T, Wynter-Blyth V, Cooper K, et al., 2016, Home remote monitoring (HRM) of patients on enhanced recovery programmes (ERP) after Oesophago-gastric (OG) Cancer Surgery: a feasibility study, 19th Annual Scientific Meeting of the Association-of-Upper-Gastrointestinal-Surgeons-of-Great-Britain-and-Ireland, Publisher: WILEY-BLACKWELL, Pages: 45-45, ISSN: 0007-1323
Peters CJ, Drake T, Kong C, et al., 2016, Multicentre national observational cohort study on variation in peri-operative care pathways following major oesophago-gastric resection, 19th Annual Scientific Meeting of the Association-of-Upper-Gastrointestinal-Surgeons-of-Great-Britain-and-Ireland, Publisher: WILEY-BLACKWELL, Pages: 47-47, ISSN: 0007-1323
Wynter-Blyth V, Osborn H, King A, et al., 2016, PREPARE: A multi-dimensional personalized prehabilitation programme in patients undergoing surgery for oesophago-gastric cancer, 19th Annual Scientific Meeting of the Association-of-Upper-Gastrointestinal-Surgeons-of-Great-Britain-and-Ireland, Publisher: WILEY-BLACKWELL, Pages: 44-44, ISSN: 0007-1323
Saleh M, Cheruvu MS, Moorthy K, et al., 2016, Laparoscopic sleeve gastrectomy using a synthetic bioabsorbable staple line reinforcement material: Post-operative complications and 6 year outcomes., Annals of Medicine and Surgery, Vol: 10, Pages: 83-87, ISSN: 2049-0801
BACKGROUND: Gastric leak after laparoscopic sleeve gastrectomy (LSG) is a serious complication. Currently, the literature lacks long-term outcomes in LSG and leak rates after reinforcement of the staple line. The aims are two-fold: to present leak rates from using staple line reinforcement and six year outcomes of LSG in relation to resolution of obesity-related comorbidities and long-term weight loss. MATERIALS AND METHODS: This is a single-institution, retrospectively reviewed study of 204 patient case files. Data from all patients undergoing LSG between December 2007 and May 2013 was collected. RESULTS: The total complication rate was 6.9% (14/204), with no recorded staple line leaks. The mean postoperative Body Mass Index (BMI) at 1 year, 2 years, 3 years, 4 years, 5 years, and 6 years was 39.3 ± 8, 38.7 ± 8, 40.4 ± 9, 40.5 ± 10, 43.0 ± 10, and 42.4 ± 7, respectively. The mean % excess weight loss at 1 year, 3 years, and 6 years was 48.4 ± 19, 51.7 ± 28, and 41.0 ± 21, respectively. There were no significant differences between follow-ups at year 1 and 3 (p > 0.05), and between year 3 and 6 (p > 0.05) for the mean % excess weight loss. The resolution rates for all patients were 74%, 61%, 79%, and 90% for hypertension, hypercholesterolemia, diabetes mellitus type 2 and obstructive sleep apnea, respectively. CONCLUSION: The synthetic bioabsorbable reinforcement material shows no staple line leaks making it safe to use. LSG as a procedure had a high resolution of obesity-related comorbidities as well as sustainable long-term weight loss.
Wynter-Blyth V, Bouras G, Kynoch M, et al., 2016, Evaluation of the impact of the PREPARE for surgery, a multi-modal optimization programme in oesophago-gastric (OG) surgery, International Surgical Congress of the Association-of-Surgeons-of-Great-Britain-and-Ireland, Publisher: WILEY-BLACKWELL, Pages: 38-38, ISSN: 0007-1323
Moussa O, Winter-Blyth V, Thomas R, et al., 2016, Sarcopenia and frailty measurements as predictors of outcome in gastro-oesophageal resections; A parallel study, International Surgical Congress of the Association-of-Surgeons-of-Great-Britain-and-Ireland, Publisher: WILEY-BLACKWELL, Pages: 128-128, ISSN: 0007-1323
Moussa O, Thomas R, Wynter-Blyth V, et al., 2016, Sarcopenia as a Predictor of Postoperative Respiratory Complications in Gastro-oesophageal resections; A myth?, International Surgical Congress of the Association-of-Surgeons-of-Great-Britain-and-Ireland, Publisher: WILEY-BLACKWELL, Pages: 18-18, ISSN: 0007-1323
Symons NRA, Moorthy K, Vincent CA, 2016, Reliability in the process of care during emergency general surgical admission: A prospective cohort study, INTERNATIONAL JOURNAL OF SURGERY, Vol: 32, Pages: 143-149, ISSN: 1743-9191
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