Publications
64 results found
Burns EM, Mamidanna R, Currie A, et al., 2014, The role of caseload in determining outcome following laparoscopic colorectal cancer resection: an observational study, SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES, Vol: 28, Pages: 134-142, ISSN: 0930-2794
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- Citations: 8
Burns EM, Bottle A, Almoudaris AM, et al., 2013, Hierarchical multilevel analysis of increased caseload volume and postoperative outcome after elective colorectal surgery, BRITISH JOURNAL OF SURGERY, Vol: 100, Pages: 1531-U1538, ISSN: 0007-1323
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- Citations: 28
Howell A-M, Bouras G, Burns EM, 2013, IMPROVING PATIENT SAFETY Harnessing clinical solving abilities through safety reporting to drive quality improvement in the NHS, BMJ-BRITISH MEDICAL JOURNAL, Vol: 347, ISSN: 1756-1833
Howell AM, Panesar S, Burns EM, et al., 2013, Preventing surgical harm, a systematic review of methods to reduce adverse events in surgery, International Surgical Congress of the Association-of-Surgeons-of-Great-Britain-and-Ireland (ASGBI), Publisher: WILEY-BLACKWELL, Pages: 194-194, ISSN: 0007-1323
Ashraf SQ, Burns EM, Jani A, et al., 2013, The economic impact of anastomotic leakage after anterior resections in English NHS hospitals: are we adequately remunerating them?, COLORECTAL DISEASE, Vol: 15, Pages: E190-E198, ISSN: 1462-8910
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- Citations: 82
Lee H, Beales S, Kinross J, et al., 2013, The extent of rationing of surgical procedures in England, LANCET, Vol: 381, Pages: 534-535, ISSN: 0140-6736
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- Citations: 3
Burns EM, Currie A, Bottle A, et al., 2013, Minimal-access colorectal surgery is associated with fewer adhesion-related admissions than open surgery, Br J Surg, Vol: 100, Pages: 152-159, ISSN: 1365-2168
BACKGROUND: This study aimed to describe national intermediate-term admission rates for incisional hernia or clinically apparent adhesions following colorectal surgery, and to compare rates following laparoscopic and open approaches. METHODS: Patients undergoing primary colorectal resection between 2002 and 2008 were included from the Hospital Episode Statistics database. Subsequent inpatient admissions were extracted for up to 3 years after the initial operation or to the end of the study period. Outcomes examined were admissions with a diagnosis of, or operative interventions for, incisional hernia or adhesions. RESULTS: A total of 187 148 patients were included between 2002 and 2008, with median follow-up of 31.8 (interquartile range 13.1-35.3) months. Some 8885 (4.7 per cent) of these patients were admitted with a diagnosis of, or underwent a repair of, an incisional hernia. In multiple regression analysis, use of laparoscopy was not a predictor of operative intervention for incisional hernia (odds ratio 1.09, 95 per cent confidence interval (c.i.) 0.99 to 1.21; P = 0.083). Some 15 125 (8.1 per cent) of the patients were admitted with a diagnosis of adhesions or had a procedure for division of adhesions. Overall, 3.5 per cent (6637 of 187 148) of patients underwent adhesiolysis. Patients selected for a laparoscopic procedure had lower rates of admission for adhesions (6.3 per cent (692 of 11 013) for laparoscopic versus 8.2 per cent (14 433 of 176 135) for open surgery; P < 0.001) and reintervention for adhesions (2.8 per cent (305 of 11 013) versus 3.6 per cent (6325 of 176 135) respectively; P < 0.001) than those undergoing an open procedure. In multiple regression analysis, patients selected for a laparoscopic procedure had lower subsequent intervention rates for adhesions (odds ratio 0.80, 95 per cent c.i. 0.71 to 0.90; P < 0.001). DISCUSSION: Patients undergoing colorectal resection who are selected for the laparoscopic approach have a lower risk o
Mamidanna R, Eid-Arimoku L, Almoudaris AM, et al., 2012, Poor 1-Year Survival in Elderly Patients Undergoing Nonelective Colorectal Resection, DISEASES OF THE COLON & RECTUM, Vol: 55, Pages: 788-796, ISSN: 0012-3706
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- Citations: 34
Burns EM, Faiz OD, 2012, Letter Re: "Hospital Variation in 30-Day Mortality After Colorectal Cancer Surgery in Denmark: The Contribution of Hospital Volume and Patient Characteristics.", ANNALS OF SURGERY, Vol: 255, Pages: E19-E19, ISSN: 0003-4932
Burns EM, Faiz OD, 2012, Re: How often do patients return to the operating room after colorectal surgery?, COLORECTAL DISEASE, Vol: 14, Pages: 642-642, ISSN: 1462-8910
Almoudaris AM, Burns E, Bottle A, et al., 2012, Single measures of performance do not reflect overall institutional quality in colorectal cancer surgery, Gut
Objective To evaluate overall performance of English colorectal cancer surgical units identified as outliers for a single quality measure—30 day inhospital mortality.Design 144 542 patients that underwent primary major colorectal cancer resection between 2000/2001 and 2007/2008 in 149 English National Health Service units were included from hospital episodes statistics. Casemix adjusted funnel plots were constructed for 30 day inhospital mortality, length of stay, unplanned readmission within 28 days, reoperation, failure to rescue-surgical (FTR-S) and abdominoperineal excision (APE) rates. Institutional performance was evaluated across all other domains for institutions deemed outliers for 30 day mortality. Outliers were those that lay on or breached 3 SD control limits. ‘Acceptable’ performance was defined if units appeared under the upper 2 SD limit.Results 5 high mortality outlier (HMO) units and 15 low mortality outlier (LMO) units were identified. Of the five HMO units, two were substandard performance outliers (ie, above 3 SD) on another metric (both on high reoperation rates). A further two HMO institutions exceeded the second but not the third SD limits for substandard performance on other outcome metrics. One of the 15 LMO units exceeded 3 SD for substandard performance (APE rate). One LMO institution exceeded the second but not the third SD control limits for high reoperation rates. Institutional mortality correlated with FTR-S and reoperations (R=0.445, p<0.001 and R=0.191, p<0.020 respectively).Conclusions Performance appraisal in colorectal surgery is complex and dependent on stakeholder perspective. Benchmarking units solely on a single performance measure is over simplistic and potentially hazardous. A global appraisal of institutional outcome is required to contextualise performance.
Faiz O, Burns E, Nicholls J, 2011, Authors' reply: Volume analysis of outcome following restorative proctocolectomy (<i>Br J Surg</i> 2011; 98: 408-417), BRITISH JOURNAL OF SURGERY, Vol: 98, Pages: 1031-1032, ISSN: 0007-1323
Burns EM, Bottle A, Aylin P, et al., 2011, Volume analysis of outcome following restorative proctocolectomy., Br J Surg, Vol: 98, Pages: 408-417
BACKGROUND: This observational study aimed to determine national provision and outcome following pouch surgery (restorative proctocolectomy, RPC) and to examine the effect of institutional and surgeon caseload on outcome. METHODS: All patients undergoing primary RPC between April 1996 and March 2008 in England were identified from the administrative database Hospital Episode Statistics. Institutions and surgeons were categorized according to the total RPC caseload performed over the study interval. RESULTS: Some 5771 primary elective pouch procedures were undertaken at 154 National Health Service hospital trusts. Median follow-up was 65 (interquartile range (i.q.r.) 28-106) months. The 30-day in-hospital mortality rate was 0·5 per cent and the 1-year overall mortality rate 1·5 per cent. Some 30·5 per cent of trusts performed fewer than two procedures per year, and 91·4 per cent of surgical teams (456 of 499) carried out 20 or fewer RPCs over 8 years. Median surgeon volume was 4 (i.q.r. 1-9) cases. Failure occurred in 6·4 per cent of cases. Low-volume surgeons operated on more patients at the extremes of age (P < 0·001) and a lower proportion with ulcerative colitis (P < 0·001). Older age, increasing co-morbidity, increasing social deprivation, and both lower provider and surgeon caseload were independent predictors of longer length of stay. Older patient age and low institutional volume status were independent predictors of failure. CONCLUSION: Many English institutions and surgeons carry out extremely low volumes of RPC surgery. Case selection differed significantly between high- and low-volume surgeons. Institutional volume and older age were positively associated with increased pouch failure.
Almoudaris AM, Burns EM, Bottle A, et al., 2011, A colorectal perspective on voluntary submission of outcome data to clinical registries., Br J Surg, Vol: 98, Pages: 132-139
BACKGROUND: The aim of the study was to identify outcome differences amongst patients undergoing resection of colorectal cancer at English National Health Service trusts using Hospital Episode Statistics (HES). A comparison was undertaken of trusts that submitted and those that did not submit, or submitted only poorly, voluntarily to a colorectal clinical registry, the National Bowel Cancer Audit Programme (NBOCAP). METHODS: The NBOCAP data set was used to classify trusts according to submitter status. HES data were used for outcome analysis. Data for major resections of colorectal cancer performed between 1 August 2007 and 31 July 2008 were obtained from HES. Trusts not submitting data to NBOCAP and those submitting less than 10 per cent of their total workload were termed 'non-submitters'. HES data for 30-day mortality, length of stay and readmission rates were compared according to submitter and non-submitter status in multifactorial analyses. RESULTS: A total of 17,722 patients were identified from HES for inclusion. Unadjusted 30-day in-hospital mortality rates were higher in non-submitting than in submitting trusts (5·2 versus 4·0 per cent; P = 0·005). Submitter status was independently associated with reduced 30-day mortality (odds ratio 0·76, 95 per cent confidence interval 0·61 to 0·96; P = 0·021) in regression analysis. CONCLUSION: A higher postoperative mortality rate following resection of colorectal cancer was found in trusts that do not voluntarily report data to NBOCAP. Implications regarding the voluntary nature of submission to such registries should be reviewed if they are to be used for outcome benchmarking.
Burns EM, Bottle A, Aylin P, et al., 2011, Variation in reoperation after colorectal surgery in England as an indicator of surgical performance: retrospective analysis of Hospital Episode Statistics, Vol: 343, ISSN: 1468-5833
OBJECTIVE: To describe national reoperation rates after elective and emergency colorectal resection and to assess the feasibility of using reoperation as a quality indicator derived from routinely collected data in England. DESIGN: Retrospective observational study of Hospital Episode Statistics (HES) data. SETTING: HES dataset, an administrative dataset covering the entire English National Health Service. PARTICIPANTS: All patients undergoing a primary colorectal resection in England between 2000 and 2008. MAIN OUTCOME MEASURES: Reoperation after colorectal resection, defined as any reoperation for an intra-abdominal procedure or wound complication within 28 days of surgery on the index or subsequent admission to hospital. RESULTS: The national reoperation rate was 6.5% (15,986/246,469). A large degree of variation was identified among institutions and surgeons. Even among institutions and surgical teams with high caseloads, threefold and fivefold differences in reoperation rates were observed between the highest and lowest performing trusts and surgeons. Of the NHS trusts studied, 14.1% (22/156) had adjusted reoperation rates above the upper 99.8% control limit. Factors independently associated with higher risk of reoperation were diagnosis of inflammatory bowel disease (odds ratio 1.33 (95% CI 1.24 to 1.42), P<0.001), presence of multiple comorbidity (odds ratio 1.34 (1.29 to 1.39), P<0.001), social deprivation (1.14 (1.08 to 1.20) for most deprived, P<0.001), male sex (1.33 (1.29 to 1.38), P<0.001), rectal resection (1.63 (1.56 to 1.71), P<0.001), laparoscopic surgery (1.11 (1.03 to 1.20), P = 0.006), and emergency admission (1.21 (1.17 to 1.26), P<0.001). CONCLUSIONS: There is large variation in reoperation after colorectal surgery between hospitals and surgeons in England. If data accuracy can be assured, reoperation may allow performance to be checked against national standards from current routinely collected data, alongside other indicator
Burns EM, Rigby E, Mamidanna R, et al., 2011, Systematic review of discharge coding accuracy, ISSN: 1741-3850
Introduction Routinely collected data sets are increasingly used for research, financial reimbursement and health service planning. High quality data are necessary for reliable analysis. This study aims to assess the published accuracy of routinely collected data sets in Great Britain. METHODS: Systematic searches of the EMBASE, PUBMED, OVID and Cochrane databases were performed from 1989 to present using defined search terms. Included studies were those that compared routinely collected data sets with case or operative note review and those that compared routinely collected data with clinical registries. RESULTS: Thirty-two studies were included. Twenty-five studies compared routinely collected data with case or operation notes. Seven studies compared routinely collected data with clinical registries. The overall median accuracy (routinely collected data sets versus case notes) was 83.2% (IQR: 67.3-92.1%). The median diagnostic accuracy was 80.3% (IQR: 63.3-94.1%) with a median procedure accuracy of 84.2% (IQR: 68.7-88.7%). There was considerable variation in accuracy rates between studies (50.5-97.8%). Since the 2002 introduction of Payment by Results, accuracy has improved in some respects, for example primary diagnoses accuracy has improved from 73.8% (IQR: 59.3-92.1%) to 96.0% (IQR: 89.3-96.3), P= 0.020. CONCLUSION: Accuracy rates are improving. Current levels of reported accuracy suggest that routinely collected data are sufficiently robust to support their use for research and managerial decision-making.
Burns EM, Bottle A, Aylin P, et al., 2011, Volume analysis of outcome following restorative proctocolectomy, The British journal of surgery, Vol: 98, Pages: 408-417, ISSN: 1365-2168
BACKGROUND: This observational study aimed to determine national provision and outcome following pouch surgery (restorative proctocolectomy, RPC) and to examine the effect of institutional and surgeon caseload on outcome. METHODS: All patients undergoing primary RPC between April 1996 and March 2008 in England were identified from the administrative database Hospital Episode Statistics. Institutions and surgeons were categorized according to the total RPC caseload performed over the study interval. RESULTS: Some 5771 primary elective pouch procedures were undertaken at 154 National Health Service hospital trusts. Median follow-up was 65 (interquartile range (i.q.r.) 28-106) months. The 30-day in-hospital mortality rate was 0.5 per cent and the 1-year overall mortality rate 1.5 per cent. Some 30.5 per cent of trusts performed fewer than two procedures per year, and 91.4 per cent of surgical teams (456 of 499) carried out 20 or fewer RPCs over 8 years. Median surgeon volume was 4 (i.q.r. 1-9) cases. Failure occurred in 6.4 per cent of cases. Low-volume surgeons operated on more patients at the extremes of age (P < 0.001) and a lower proportion with ulcerative colitis (P < 0.001). Older age, increasing co-morbidity, increasing social deprivation, and both lower provider and surgeon caseload were independent predictors of longer length of stay. Older patient age and low institutional volume status were independent predictors of failure. CONCLUSION: Many English institutions and surgeons carry out extremely low volumes of RPC surgery. Case selection differed significantly between high- and low-volume surgeons. Institutional volume and older age were positively associated with increased pouch failure.
Mamidanna R, Burns EM, Bottle A, et al., 2011, Reduced Risk of Medical Morbidity and Mortality in Patients Selected for Laparoscopic Colorectal Resection in England: A Population-Based Study, ISSN: 1538-3644
OBJECTIVES: To quantify the occurrence of significant medical complications following elective colorectal resection and investigate potential differences in medical morbidity following open and minimal access colorectal surgery. DESIGN: Retrospective analysis of Hospital Episode Statistics, which is a prospectively maintained national database. SETTING: All patients undergoing colorectal resection in National Health Service trusts in England. PATIENTS: Adult patients undergoing elective or planned surgery between April 2001 and March 2008. INTERVENTION: Colorectal resection for benign and malignant diagnoses. MAIN OUTCOME MEASURES: Mortality and morbidity at 30 days and 1 year following elective colorectal resection. RESULTS: One hundred thirty-eight thousand seven hundred thirty-five elective colorectal resections were identified between the study dates. Thirty-day in-hospital mortality was 3.4% and 1.7% following conventional and laparoscopic surgery, respectively (P < .001). Overall, the 30-day postoperative medical morbidity rate was 14.6%. Use of the minimal access approach demonstrated a significant reduction in total morbidity risk at 30 days (odds ratio, 0.79; P < .001) and 365 days (odds ratio, 0.81; P < .001) following case-mix adjustment. Multiple regression analyses demonstrated that cardiorespiratory complications and venous thromboembolism occurred less frequently during the index admission and up to 1 year following minimal access surgery when compared with the conventional approach (P < .049). CONCLUSIONS: In this population-based study, patients selected for laparoscopic colorectal resection were associated with lower risk of mortality as well as reduced cardiorespiratory and venous thromboembolic risk than those undergoing open surgery.
Almoudaris AM, Burns EM, Bottle A, et al., 2011, A colorectal perspective on voluntary submission of outcome data to clinical registries, The British journal of surgery, Vol: 98, Pages: 132-139, ISSN: 1365-2168
BACKGROUND: The aim of the study was to identify outcome differences amongst patients undergoing resection of colorectal cancer at English National Health Service trusts using Hospital Episode Statistics (HES). A comparison was undertaken of trusts that submitted and those that did not submit, or submitted only poorly, voluntarily to a colorectal clinical registry, the National Bowel Cancer Audit Programme (NBOCAP). METHODS: The NBOCAP data set was used to classify trusts according to submitter status. HES data were used for outcome analysis. Data for major resections of colorectal cancer performed between 1 August 2007 and 31 July 2008 were obtained from HES. Trusts not submitting data to NBOCAP and those submitting less than 10 per cent of their total workload were termed 'non-submitters'. HES data for 30-day mortality, length of stay and readmission rates were compared according to submitter and non-submitter status in multifactorial analyses. RESULTS: A total of 17,722 patients were identified from HES for inclusion. Unadjusted 30-day in-hospital mortality rates were higher in non-submitting than in submitting trusts (5.2 versus 4.0 per cent; P = 0.005). Submitter status was independently associated with reduced 30-day mortality (odds ratio 0.76, 95 per cent confidence interval 0.61 to 0.96; P = 0.021) in regression analysis. CONCLUSION: A higher postoperative mortality rate following resection of colorectal cancer was found in trusts that do not voluntarily report data to NBOCAP. Implications regarding the voluntary nature of submission to such registries should be reviewed if they are to be used for outcome benchmarking.
Faiz O, Haji A, Burns E, et al., 2011, Hospital stay amongst patients undergoing major elective colorectal surgery: predicting prolonged stay and readmissions in NHS hospitals, Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland, Vol: 13, Pages: 816-822, ISSN: 1463-1318
AIM: Reduced hospital stay confers clinical and economic benefits for patients and healthcare providers. This article examines the length of stay and consequent bed resource usage of patients undergoing elective excisional colorectal surgery in English NHS trusts. METHOD: All patients undergoing elective colorectal resections for malignancy between 1996 and 2006 in English NHS trusts were included from the Hospital Episode Statistics data set. Unifactorial and multifactorial analyses were performed to identify independent predictors of prolonged stay and 28-day readmission. RESULTS: Over the 10-year period, 186,013 patients underwent elective colorectal procedures in 181 NHS trusts. About 2.893 b million bed days were utilized for elective colorectal surgery. Admission stay was shorter following colonic surgery than following rectal surgery (median 11 vs 13 days, P < 0.001). A 2-day decrease in median stay was observed over the 10-year period for both colonic and rectal procedures. Readmissions within 28 days of discharge were higher following rectal excision than following colonic surgery (9.4 vs 7.6%, P < 0.001). Multiple logistic regression analyses revealed the following independent predictors of prolonged hospital stay: distal (vs proximal) bowel resection, benign pathology, open technique, increasing age, comorbidity, social deprivation and low provider volume status. Independent predictors of 28-day readmission included distal bowel resection, benign diagnosis, young age, social deprivation and high provider volume status. CONCLUSION: Patients of advanced age, with associated comorbidities, and those living in areas of social deprivation are at increased risk of prolonged stay. Targeted pre-emptive discharge planning and enhanced use of laparoscopic surgery could improve bed resource utilization.
Almoudaris AM, Burns EM, Mamidanna R, et al., 2011, Value of failure to rescue as a marker of the standard of care following reoperation for complications after colorectal resection, The British journal of surgery, Vol: 98, Pages: 1775-1783, ISSN: 1365-2168
BACKGROUND: Complication management appears to be of vital importance to differences in survival following surgery between surgical units. Failure-to-rescue (FTR) rates have not yet distinguished surgical from general medical complications. The aim of this study was to assess whether variability exists in FTR rates after reoperation for serious surgical complications following colorectal cancer resections in England. METHODS: The Hospital Episode Statistics (HES) database was used to identify patients undergoing primary resection for colorectal cancer between 2000 and 2008 in English National Health Service (NHS) trusts. Units were ranked into quintiles according to overall risk-adjusted mortality. Highest and lowest mortality quintiles were compared with respect to reoperation rates and FTR-surgical (FTR-S) rates. FTR-S was defined as the proportion of patients with an unplanned reoperation who died within the same admission. RESULTS: Some 144 542 patients undergoing resection for colorectal cancer in 150 English NHS trusts were included. On ranking according to risk-adjusted mortality, rates varied significantly between lowest and highest mortality quintiles (5.4 and 9.3 per cent respectively; P = 0.029). Lowest and highest mortality quintiles had equivalent adjusted reoperation rates (both 4.8 per cent; P = 0.211). FTR-S rates were significantly higher at units within the worst mortality quintile (16.8 versus 11.1 per cent; P = 0.002). CONCLUSION: FTR-S rates differed significantly between English colorectal units, highlighting variability in ability to prevent death in this high-risk group. This variability may represent differences in serious surgical complication management. FTR-S represents a readily collectable marker of surgical complication management that is likely to be applicable to other surgical specialties. Copyright (c) 2011 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.
Burns EM, Naseem H, Bottle A, et al., 2010, Introduction of laparoscopic bariatric surgery in England: observational population cohort study, BMJ-BRITISH MEDICAL JOURNAL, Vol: 341, ISSN: 1756-1833
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Faiz O, Brown T, Bottle A, et al., 2010, Impact of hospital institutional volume on postoperative mortality after major emergency colorectal surgery in English National Health Service Trusts, 2001 to 2005, Diseases of the colon and rectum, Vol: 53, Pages: 393-401, ISSN: 1530-0358
PURPOSE: The aim of this study was to investigate the effects of institutional volume on postoperative mortality in patients undergoing emergency major colorectal surgical procedures in England between 2001 and 2005. METHODS: All of the emergency excisional colorectal procedures performed between the above dates were included from the Hospital Episode Statistics data set. Institutions were divided into high-, medium-, and low-volume tertiles according to the total major emergency colorectal caseload. RESULTS: During the study period, 37,094 emergency excisional colorectal procedures were performed in 166 English National Health Service institutions. Overall 30-day postoperative mortality was 15.49%, increasing to 29.18% at 1 year after surgery. Overall 30- and 365-day mortality rates were similar among institutional volume tertiles (P > .05) after adjustment for age, sex, social deprivation, diagnosis, procedure type, and comorbidity score. CONCLUSION: Hospital Episode Statistics data suggest that institutions with high volumes of emergency colorectal caseload do not demonstrate lower mortality after emergency major excisional colorectal surgery.
Burns EM, Faiz O, 2010, Evolution of the surgeon--volume, patient outcome relationship, Annals of surgery, Vol: 251, Pages: 991-992, ISSN: 1528-1140
Burns EM, Faiz O, 2010, Response to Khani et al., centralization of rectal cancer surgery improves long-term survival, Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland, Vol: 12, ISSN: 1463-1318
Burns E, Naseem H, Aylin P, et al., 2010, Trends in laparoscopic bariatric surgery and comparisons of outcomes with open surgery: a national study in England 2000-2008, Electronic Poster of Distinction in Association-of-Surgeons-of-Great-Britain-and-Ireland-International-Surgical-Congress, Publisher: WILEY-BLACKWELL, Pages: 40-40, ISSN: 0007-1323
Almoudaris A, Burns E, Bottle A, et al., 2010, Do surgical units that submit data to a voluntary national colorectal cancer registry have better outcomes than those that do not?, Electronic Poster of Distinction in Association-of-Surgeons-of-Great-Britain-and-Ireland-International-Surgical-Congress, Publisher: WILEY-BLACKWELL, Pages: 43-43, ISSN: 0007-1323
Burns EM, Bottle A, Aylin P, et al., 2010, National outcomes following restorative proctocolectomy in England, Electronic Poster of Distinction in Association-of-Surgeons-of-Great-Britain-and-Ireland-International-Surgical-Congress, Publisher: WILEY-BLACKWELL, Pages: 72-72, ISSN: 0007-1323
Burns E, Bottle A, Faiz O, et al., 2010, The role of volume in bariatric surgery, Electronic Poster of Distinction in Association-of-Surgeons-of-Great-Britain-and-Ireland-International-Surgical-Congress, Publisher: WILEY-BLACKWELL, Pages: 72-72, ISSN: 0007-1323
Burns E, Bottle A, Aylin P, et al., 2010, Examining differences in case selection between surgeons with differing surgical caseload in pouch surgery, Electronic Poster of Distinction in Association-of-Surgeons-of-Great-Britain-and-Ireland-International-Surgical-Congress, Publisher: WILEY-BLACKWELL, Pages: 131-131, ISSN: 0007-1323
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