313 results found
Panhelleux B, Shalhoub J, Silverman A, et al., 2021, A review of through-knee amputation, Vascular, ISSN: 0967-2109
Objectives: Through knee amputation (TKA) is an umbrella term for several different surgical techniques, which may affect clinical and functional outcomes. This makes it hard to evaluate the benefits and need for a TKA approach. This paper seeks to: (1) Determine the number of TKAs performed compared with other major lower limb amputations (MLLA) in England over the past decade; (2) identify the theoretical concepts behind TKA surgical approaches and their potential effect on functional and clinical outcomes; and (3) provide a platform for discussion and research on TKA and surgical outcomes.Methods: National Health Service Hospital Episodes Statistics were used to obtain recent numbers of MLLAs in England. EMBASE and MEDLINE were searched using a systematic approach with predefined criteria for relevant literature on TKA surgery.Results: In the past decade, 4.6% of MLLA in England were TKAs. Twenty-six articles presenting TKA surgical techniques met our criteria. These articles detailed three TKA surgical techniques; the classical approach, which keeps the femur intact and retains the patella; the Mazet technique, which shaves the femoral condyles into a box shape; and the Gritti-Stokes technique, which divides the femur proximal to the level of the condyles and attaches the patella at the distal cut femur.Conclusions: TKA has persisted as a surgical approach over the past decade, with three core approaches identified. Studies reporting clinical, functional, and biomechanical outcomes of TKA frequently fail to distinguish between the 3 distinct and differing approaches, making direct comparisons difficult. Future studies that compare TKA approaches to one another and to other amputation levels are needed.
Waldron C-A, Gwilym BL, Thomas-Jones E, et al., 2021, The PERCEIVE quantitative study: PrEdiction of Risk and Communication of outcome following major lower limb amputation: protocol for a collaboratiVE study, BJS Open, ISSN: 2474-9842
BackgroundAccurate prediction of outcomes following surgery with high morbidity and mortality rates is essential for informed shared decision-making between patients and clinicians. It is unknown how accurately healthcare professionals predict outcomes following major lower limb amputation (MLLA). Several MLLA outcome prediction tools have been developed. These could be valuable in clinical practice, but most require validation in independent cohorts before routine clinical use can be recommended. Our primary aim is to evaluate the accuracy of healthcare professionals’ predictions of outcomes in adult patients undergoing MLLA for complications of chronic limb threatening ischaemia (CLTI) or diabetes. Secondary aims include the validation of existing outcome prediction tools.MethodThis study is an international, multicentre prospective observational study including adult patients undergoing a primary MLLA for CLTI or diabetes. Healthcare professionals’ accuracy in predicting outcomes at 30-days (mortality, morbidity and MLLA revision) and 1-year (mortality, MLLA revision and ambulation) will be evaluated. Sixteen existing outcome prediction tools specific to MLLA will be examined for validity. Data collection began on 1st October 2020, the end of follow-up will be 1st May 2022. The C-statistic, Hosmer-Lemeshow test, reclassification tables, and Brier score will be used to evaluate the predictive performance of healthcare professionals and prediction tools, respectively.Study registration and disseminationThis study will be registered locally at each centre in accordance with local policies before commencing data collection, overseen by local clinician leads. Results will be disseminated to all centres, and any subsequent presentation(s) and/or publication(s) will follow a collaborative co-authorship model.
DeLago AJ, Singh H, Jani C, et al., 2021, An observational epidemiological study to analyze Intracerebral Hemorrhage Across the United States: Incidence and Mortality Trends from 1990 to 2017, Journal of Stroke and Cerebrovascular Diseases, ISSN: 1052-3057
Goodall R, Salciccioli JD, Davies AH, et al., 2021, Trends in peripheral arterial disease incidence and mortality in EU15+ countries 1990-2017., European Journal of Preventive Cardiology, Vol: 28, Pages: 1201-1213, ISSN: 2047-4873
AIMS: The aim was to assess trends in peripheral arterial disease (PAD) incidence and mortality rates in European Union(15+) countries between 1990 and 2017. METHODS AND RESULTS: This observational study used data obtained from the 2017 Global Burden of Disease study. Age-standardised mortality and incidence rates from PAD were extracted from the Global Health Data Exchange for EU15+ countries for the years 1990-2017. Trends were analysed using Joinpoint regression analysis. Between 1990 and 2017, the incidence of PAD decreased in all 19 EU15+ countries for females, and in 18 of 19 countries for males. Increasing PAD incidence was observed only for males in the United States (+1.4%). In 2017, the highest incidence rates were observed in Denmark and the United States for males (213.6 and 202.3 per 100,000, respectively) and in the United States and Canada for females (194.8 and 171.1 per 100,000, respectively). There was a concomitant overall trend for increasing age-standardised mortality rates in all EU15+ countries for females, and in 16 of 19 EU15+ countries for males between 1990 and 2017. Italy (-25.1%), Portugal (-1.9%) and Sweden (-0.6%) were the only countries with reducing PAD mortality rates in males. The largest increases in mortality rates were observed in the United Kingdom (males +140.4%, females +158.0%) and the United States (males +125.7%, females +131.2%). CONCLUSIONS: We identify shifting burden of PAD in EU15+ countries, with increasing mortality rates despite reducing incidence. Strong evidence supports goal-directed medical therapy in reducing PAD mortality - population-wide strategies to improve compliance to optimal goal-directed medical therapy are warranted.
Houdmont J, Daliya P, Theophilidou E, et al., 2021, Burnout among surgeons in the United Kingdom during the COVID-19 pandemic: A cohort study, World Journal of Surgery, ISSN: 0364-2313
Gueroult A, Al-Balah A, Shalhoub J, et al., 2021, Nickel hypersensitivity and endovascular devices: a systematic review and meta-analysis, Heart, ISSN: 1355-6037
Objective Nickel allergy is common; endovascular specialists are often confronted with nickel allergic patients ahead of the implantation of endovascular devices, many of which are nickel-containing. Our aim was to elucidate whether nickel hypersensitivity is significantly associated with worse or adverse outcomes after placement of a nickel-containing endovascular device.Methods Inclusion criteria were: endovascular and transcatheter procedures for coronary, structural heart, neurovascular and peripheral vascular pathology involving nickel-allergic patients. All adverse outcomes were included as defined by included studies. A systematic review and meta-analysis were undertaken using a random-effects model. Searches of MEDLINE and EMBASE were conducted for articles published 1947–2019.Results 190 records were identified, 78 articles were included for qualitative synthesis and 15 met criteria for meta-analysis. Patch-test confirmed nickel allergy was associated with an increased risk of adverse outcomes following implantation of a nickel-containing endovascular device (n=14 articles, 1740 patients; OR 2.61, 95% CI 1.41 to 4.85). This finding further was observed in coronary (n=12 articles, 1624 patients; OR 1.94, 95% CI 1.16 to 3.23) and structural heart subgroups (n=2 articles, 83 patients; OR 52.28, 95% CI 1.31 to 2079.14), but not in the neurovascular subgroup (n=1 article, 33 patients; OR 3.04, 95% CI 0.59 to 15.72) or with a patient-reported history of nickel allergy (n=2 articles, 207 patients; OR 2.14, 95% CI 0.23 to 19.70).Conclusions Patch-tested nickel allergy is associated with an increased risk of adverse outcomes following endovascular device implantation and alternative treatment options should be considered. Specialists faced with patients’ self-reporting nickel allergy should consider proceeding to diagnostic patch-testing.
Jani C, Marshall D, Singh H, et al., 2021, Lung cancer mortality in Europe and the United States between 2000 and 2017: an observational analysis, European Respiratory Journal Open Research, ISSN: 2312-0541
Background The lung is the most common site for cancer and has the highest worldwide cancer-related mortality. Our study reports and compares trends in lung cancer mortality in the United States (US) and 26 European countries.Study design and methods Lung cancer mortality data were extracted for males and females for each of the years 2000–2017 from the World Health Organization (WHO) Mortality and the Centers for Disease Control and Prevention (CDC) WONDER databases. Lung cancer mortality trends were compared using Joinpoint regression analysis, and male-to-female mortality ratios were calculated.Results Down-trending lung cancer mortality rates were observed in males in all countries except Cyprus and Portugal between 2000 and 2017. In females, increasing mortality rates were observed in 22 of the 27 countries analyzed. Latvia had the highest estimated annual percentage change (EAPC) in male mortality (−9.6%) between 2013–2015. In the US, EAPCs were −5.1% for males and −4.2% for females between 2014–2017. All countries had an overall decrease in the ratio of male-to-female lung cancer mortality. The most recent observation of median male-to-female mortality was 2.26 (IQR 1.92–4.05). The countries with the greatest current sex disparity in lung cancer mortality were Lithuania (5.51) and Latvia (5.00).Conclusion Between 2000 and 2017, lung cancer mortality rates were decreasing for males in Europe and the US, whereas increasing lung cancer mortality rates were generally observed in females. There is a persistent but decreasing sex-mortality gap, with men having persistently greater lung cancer mortality but with rates decreasing faster than women.FootnotesThis manuscript has recently been accepted for publication in the ERJ Open Research. It is published here in its accepted form prior to copyediting and typesetting by our production team. After these production processes are complete and the authors have approved the result
Otunla A, Shanmugarajah K, Madariaga M, et al., 2021, Chronic rejection and atherosclerosis in post-transplant cardiovascular mortality: two sides of the same coin, Heart Lung and Circulation, ISSN: 1443-9506
Post-transplant cardiovascular disease (CVD) is the single most common cause of death in solid organ transplant recipients. The prevailing school of thought is that post-transplant CVD is driven by the same underlying atherosclerotic processes as the CVD of aging seen in the general population. This is reflected in current management strategies, which focus on the minimisation of traditional cardiovascular risk factors. In this article, we argue that atherosclerosis is not the sole aetiology of post-transplant CVD. Instead, chronic rejection drives post-transplant CVD through an antibody-mediated systemic vasculopathy termed systemic accelerated arteriosclerosis (SAA). SAA is fundamentally distinct from atherosclerosis, associated with unique histology, pathophysiology and risk factors. In order to effectively manage post-transplant CVD, SAA needs to be addressed in current management strategies through revised risk factor minimisation and use of immunomodulatory pharmaceuticals.
Hartley A, Shalhoub J, Khamis R, 2021, Trends in mortality from aortic stenosis in Europe: 2000-2017, Frontiers in Cardiovascular Medicine, Vol: 8, Pages: 1-9, ISSN: 2297-055X
BackgroundTrends in mortality from aortic stenosis across European countries are not wellunderstood, especially given the significant growth in transcatheter aortic valveimplantation (TAVI) in the last 10 years.MethodsAge-standardised death rates were extracted from the World Health OrganisationMortality Database, using the International Classification of Diseases 10th editioncode for non-rheumatic aortic stenosis for those aged >45 years between 2000 and2017. The UK and countries from the European Union with at least 1,000,000inhabitants and at least 50% available datapoints over the study period were included:a total of 23 countries. Trends were described using Joinpoint regression analysis.ResultsNo reductions in mortality were demonstrated across all countries 2000-2017. Largeincreases in mortality were found for Croatia, Poland and Slovakia for both sexes(>300% change). Mortality plateaued in Germany from 2008 in females and 2012 inmales, whilst mortality in the Netherlands declined for both sexes from 2007. Mortalitydifferences between the sexes were observed, with greater mortality for males thanfemales across most countries.ConclusionsMortality from aortic stenosis has increased across Europe from 2000 to 2017. Thereare, however, sizable differences in mortality trends between Eastern and WesternEuropean countries. The need for health resource planning strategies to specificallytarget AS, particularly given the expected increase with aging populations, ishighlighted.
Jani C, Salciccioli I, Rupal A, et al., 2021, Trends in breast cancer mortality between 2001 and 2017: an observational study in E.U. and U.K., Journal of Global Oncology, ISSN: 2378-9506
Introduction:Breast cancer is the most common cancer in women worldwide, representing 25.4% of the newly diagnosed cases in 2018. The past two decades have seen advancements in screening technologies, guidelines, as well as newer modalities of treatment. Our study reports and compares trends in breast cancer mortality in the European Union (E.U.) and the U.K.Methods:We utilized the World Health Organization (WHO) Mortality Database. We extracted Breast Cancer mortality data from 2001 to 2017 based on the ICD 10 system. Calculations:Crude mortality rates were dichotomized by sex and reported by year. We computed Age Standardized Death Rates (ASDRs) per 100,000 population using the World Standard Population. Breast cancer mortality trends were compared using Joinpoint regression analysis.Results:We analyzed data from 24 E.U. countries, including the U.K. For females, breast cancer mortality was observed to be down-trending in all countries except Croatia, France, and Poland. For the most recent female data, the highest ASDR for breast cancer was identified in Croatia (19.29/100,000), and the lowest ASDR was noted in Spain (12.8/100,000). Denmark had the highest change in ASDR as well as the highest Estimated Annual Percentage Change (EAPC) of -3.2%. For males, breast cancer mortality decreased in 18 countries, with the largest relative reduction observed in Denmark with an EAPC of -27.5%. For the most recent male data, the highest ASDR for breast cancer was identified in Latvia (0.54/100,000).Conclusion:Breast cancer mortality rates have down trended in most E.U. countries between 2001 to 2017 for both males and females. Given the observational nature of this study, causality to the observed trends cannot be reliably ascribed. However, possible contributing factors should be considered and subject to further study.
Jani C, Patel K, Walker A, et al., 2021, Trends of HIV mortality between 2001 and 2018: an observational analysis, Tropical Medicine and Infectious Disease, Vol: 6, Pages: 1-14, ISSN: 2414-6366
Since the beginning of the epidemic in the early 1980s, HIV-related illness has led to the deaths of over 32.7 million individuals. The objective of this study was to describe current mortality rates for HIV through an observational analysis of HIV mortality data from 2001 to 2018 from the World Health Organization (WHO) Mortality Database. We computed age standardized death rates (ASDRs) per 100,000 population using the World Standard Population. We plotted trends using Locally weighted scatterplot smoothing (LOWESS). Data for females was available for 42 countries. 31/48 (64.60%) and 25/42 (59.52%) countries showed decreases in mortality in males and females, respectively. South Africa had the highest ASDRs for both males (467.7/100,000) and females (391.1/100,000). The lowest mortalities were noted in Egypt for males (0.2/100,000) and in Japan for females (0.01/100,000). Kyrgyzstan had the greatest increase in male (+6998.6%). Estonia had the greatest increase in female (+5877.56%). Disparity between Egypt (lowest) and South Africa (highest) was 3042-fold for males, whereas it was 43,454-fold for females between Japan (lowest) and South Africa (highest). Although there has been a decrease in mortality attributed to HIV among most of the countries studied, a rising trend remains in a number of developing countries.
Khatri A, Machin M, Vijay A, et al., 2021, A Review of current and future antithrombotic strategies in surgical patients–leaving the graduated compression stockings behind?, Journal of Clinical Medicine, Vol: 10, ISSN: 2077-0383
Venous thromboembolism (VTE) remains an important consideration within surgery, with recent evidence looking to refine clinical guidance. This review provides a contemporary update of existing clinical evidence for antithrombotic regimens for surgical patients, providing future directions for prophylaxis regimens and research. For moderate to high VTE risk patients, existing evidence supports the use of heparins for prophylaxis. Direct oral anticoagulants (DOACs) have been validated within orthopaedic surgery, although there remain few completed randomised controlled trials in other surgical specialties. Recent trials have also cast doubt on the efficacy of mechanical prophylaxis, especially when adjuvant to pharmacological prophylaxis. Despite the ongoing uncertainty in higher VTE risk patients, there remains a lack of evidence for mechanical prophylaxis in low VTE risk patients, with a recent systematic search failing to identify high-quality evidence. Future research on rigorously developed and validated risk assessment models will allow the better stratification of patients for clinical and academic use. Mechanical prophylaxis’ role in modern practice remains uncertain, requiring high-quality trials to investigate select populations in which it may hold benefit and to explore whether intermittent pneumatic compression is more effective. The validation of DOACs and aspirin in wider specialties may permit pharmacological thromboprophylactic regimens that are easier to administer.
Goodall R, Salciccioli JD, Davies AH, et al., 2021, Trends in peripheral arterial disease incidence and mortality in EU15+ countries 1990-2017, European Journal of Preventive Cardiology, Vol: 28, Pages: 1201-1213, ISSN: 2047-4873
AIMS: The aim was to assess trends in peripheral arterial disease (PAD) incidence and mortality rates in European Union(15+) countries between 1990 and 2017. METHODS AND RESULTS: This observational study used data obtained from the 2017 Global Burden of Disease study. Age-standardised mortality and incidence rates from PAD were extracted from the Global Health Data Exchange for EU15+ countries for the years 1990-2017. Trends were analysed using Joinpoint regression analysis.Between 1990 and 2017, the incidence of PAD decreased in all 19 EU15+ countries for females, and in 18 of 19 countries for males. Increasing PAD incidence was observed only for males in the United States (+1.4%). In 2017, the highest incidence rates were observed in Denmark and the United States for males (213.6 and 202.3 per 100,000, respectively) and in the United States and Canada for females (194.8 and 171.1 per 100,000, respectively). There was a concomitant overall trend for increasing age-standardised mortality rates in all EU15+ countries for females, and in 16 of 19 EU15+ countries for males between 1990 and 2017. Italy (-25.1%), Portugal (-1.9%) and Sweden (-0.6%) were the only countries with reducing PAD mortality rates in males. The largest increases in mortality rates were observed in the United Kingdom (males +140.4%, females +158.0%) and the United States (males +125.7%, females +131.2%). CONCLUSIONS: We identify shifting burden of PAD in EU15+ countries, with increasing mortality rates despite reducing incidence. Strong evidence supports goal-directed medical therapy in reducing PAD mortality - population-wide strategies to improve compliance to optimal goal-directed medical therapy are warranted.
Gwilym B, Maheswaran R, Edwards A, et al., 2021, Income deprivation and groin wound surgical site infection: cross-sectional analysis from the Groin wound Infection after Vascular Exposure (GIVE) multicentre cohort study, Surgical Infections, ISSN: 1096-2964
COVIDSurg Collaborative, GlobalSurg Collaborative, 2021, SARS‐CoV‐2 infection and venous thromboembolism after surgery: an international prospective cohort study, Anaesthesia, Pages: 1-12, ISSN: 0003-2409
SARS-CoV-2 has been associated with an increased rate of venous thromboembolism in critically ill patients. Since surgical patients are already at higher risk of venous thromboembolism than general populations, this study aimed to determine if patients with peri-operative or prior SARS-CoV-2 were at further increased risk of venous thromboembolism. We conducted a planned sub-study and analysis from an international, multicentre, prospective cohort study of elective and emergency patients undergoing surgery during October 2020. Patients from all surgical specialties were included. The primary outcome measure was venous thromboembolism (pulmonary embolism or deep vein thrombosis) within 30 days of surgery. SARS-CoV-2 diagnosis was defined as peri-operative (7 days before to 30 days after surgery); recent (1–6 weeks before surgery); previous (≥7 weeks before surgery); or none. Information on prophylaxis regimens or pre-operative anti-coagulation for baseline comorbidities was not available. Postoperative venous thromboembolism rate was 0.5% (666/123,591) in patients without SARS-CoV-2; 2.2% (50/2317) in patients with peri-operative SARS-CoV-2; 1.6% (15/953) in patients with recent SARS-CoV-2; and 1.0% (11/1148) in patients with previous SARS-CoV-2. After adjustment for confounding factors, patients with peri-operative (adjusted odds ratio 1.5 (95%CI 1.1–2.0)) and recent SARS-CoV-2 (1.9 (95%CI 1.2–3.3)) remained at higher risk of venous thromboembolism, with a borderline finding in previous SARS-CoV-2 (1.7 (95%CI 0.9–3.0)). Overall, venous thromboembolism was independently associated with 30-day mortality (5.4 (95%CI 4.3–6.7)). In patients with SARS-CoV-2, mortality without venous thromboembolism was 7.4% (319/4342) and with venous thromboembolism was 40.8% (31/76). Patients undergoing surgery with peri-operative or recent SARS-CoV-2 appear to be at increased risk of postoperative venous thromboembolism compared with patients with no his
Gottardi R, Wyss TR, van den Berg JC, et al., 2021, Current trends in reduction or elimination of the aortic impulse during stent-graft deployment and balloon moulding during thoracic endovascular aortic repair, European Journal of Cardio-Thoracic Surgery, ISSN: 1010-7940
<jats:title>Abstract</jats:title> <jats:p /> <jats:sec> <jats:title>OBJECTIVES</jats:title> <jats:p>A survey was performed to evaluate the methods used for reduction or elimination of the aortic impulse (REAI) to facilitate precise stent graft placement and balloon moulding during thoracic endovascular aortic repair (TEVAR).</jats:p> </jats:sec> <jats:sec> <jats:title>METHODS</jats:title> <jats:p>A total of 127 physicians (1 per hospital) were contacted and asked to fill out a short, comprehensive questionnaire on an internet-based platform.</jats:p> </jats:sec> <jats:sec> <jats:title>RESULTS</jats:title> <jats:p>Fifty physicians (39.4%) responded and completed the survey. Routine use of REAI for stent graft deployment is most frequently used in the ascending aorta and less frequently in the aortic arch and the descending aorta (86.4% vs 69.4% vs 56%). Some physicians based the decision of whether to use REAI on the type of stent graft in the respective location (13.6% vs 24.5% vs 24.0%). Stent-graft deployment without REAI, irrespective of the type of stent graft used, was never done in the ascending aorta (0.0%), in 3 centres in the aortic arch (6.1%) and in 10 centres in the descending aorta (20%). The REAI method most frequently used was dependent on the aortic segment (ascending aorta vs aortic arch vs descending aorta) rapid right ventricular pacing (90.9% vs 59.2% vs 28.0%), followed by pharmacological blood pressure reduction (13.6% vs 53.1% vs 64.0%) and venous inflow occlusion (13.6% vs 14.3% vs 4.0%), respectively. Tip capture and non-occlusive deployment systems were frequently quoted as reasons for not using REAI.</jats:p> </jats:sec>
COVIDSurg Collaborative, GlobalSurg Collaborative, Shalhoub J, 2021, Effects of pre-operative isolation on postoperative pulmonary complications after elective surgery: an international prospective cohort study, Anaesthesia, ISSN: 0003-2409
Salciccioli I, Zhou CD, Okonji EC, et al., 2021, European Trends in Cervical Cancer Mortality in Relation to National Screening Programs, 1985-2014, Cancer Epidemiology: the international journal of cancer epidemiology, detection and prevention, ISSN: 0361-090X
Cardiothoracic Interdisciplinary Research Network and COVIDSurg Collaborative, 2021, Early outcomes and complications following cardiac surgery in patients testing positive for coronavirus disease 2019: An international cohort study., Journal of Thoracic and Cardiovascular Surgery, Vol: 162, Pages: e355-e372, ISSN: 0022-5223
Proctor D, Goodall R, Salciccioli J, et al., 2021, Re "International Variations and Sex Disparities in the Treatment of Peripheral Arterial Occlusive Disease: A Report from VASCUNET and the International Consortium of Vascular Registries", European Journal of Vascular and Endovascular Surgery, Vol: 62, Pages: 320-321, ISSN: 1078-5884
Goodall R, Alazawi A, Hughes W, et al., 2021, Trends in type 2 diabetes mellitus disease burden in European Union countries between 1990 and 2019, Scientific Reports, Vol: 11, ISSN: 2045-2322
This observational study aimed to assess trends in type 2 diabetes mellitus (T2DM) disease burden in European Union countries for the years 1990–2019. Sex specific T2DM age-standardised prevalence (ASPRs), mortality (ASMRs) and disability-adjusted life-year rates (DALYs) per 100,000 population were extracted from the Global Burden of Disease (GBD) Study online results tool for each EU country (inclusive of the United Kingdom), for the years 1990–2019. Trends were analysed using Joinpoint regression analysis. Between 1990 and 2019, increases in T2DM ASPRs were observed for all EU countries. The highest relative increases in ASPRs were observed in Luxembourg (males + 269.1%, females + 219.2%), Ireland (males + 191.9%, females + 165.7%) and the UK (males + 128.6%, females + 114.6%). Mortality trends were less uniform across EU countries, however a general trend towards reducing T2DM mortality was observed, with ASMRs decreasing over the 30-year period studied in 16/28 countries for males and in 24/28 countries for females. The UK observed the highest relative decrease in ASMRs for males (− 46.9%). For females, the largest relative decrease in ASMRs was in Cyprus (− 67.6%). DALYs increased in 25/28 countries for males and in 17/28 countries for females between 1990 and 2019. DALYs were higher in males than females in all EU countries in 2019. T2DM prevalence rates have increased across EU countries over the last 30 years. Mortality from T2DM has generally decreased in EU countries, however trends were more variable than those observed for prevalence. Primary prevention strategies should continue to be a focus for preventing T2DM in at risk groups in EU countries.
Rupal A, Singh H, Jani C, et al., 2021, TRENDS IN PULMONARY TB MORTALITY BETWEEN 1985 AND 2018: AN OBSERVATIONAL STUDY, Chest 2021
Khatri A, Davies A, Shalhoub J, 2021, Mechanical Prophylaxis for Venous Thromboembolism Prevention in Obese Individuals, Phlebology, ISSN: 0268-3555
COVIDSurg Collaborative Co-authors, 2021, Machine learning risk prediction of mortality for patients undergoing surgery with perioperative SARS-CoV-2: the COVIDSurg mortality score, British Journal of Surgery, Vol: 108, Pages: 1274-1292, ISSN: 0007-1323
Since the beginning of the COVID-19 pandemic tens of millions of operations have been cancelled1 as a result of excessive postoperative pulmonary complications (51.2 per cent) and mortality rates (23.8 per cent) in patients with perioperative SARS-CoV-2 infection2. There is an urgent need to restart surgery safely in order to minimize the impact of untreated non-communicable disease.As rates of SARS-CoV-2 infection in elective surgery patients range from 1–9 per cent3–8, vaccination is expected to take years to implement globally9 and preoperative screening is likely to lead to increasing numbers of SARS-CoV-2-positive patients, perioperative SARS-CoV-2 infection will remain a challenge for the foreseeable future.To inform consent and shared decision-making, a robust, globally applicable score is needed to predict individualized mortality risk for patients with perioperative SARS-CoV-2 infection. The authors aimed to develop and validate a machine learning-based risk score to predict postoperative mortality risk in patients with perioperative SARS-CoV-2 infection.
Goodall RJ, Hughes WRM, Salciccioli JD, et al., 2021, Incongruous trends in peripheral arterial disease and amputation in Australia, Publisher: OXFORD UNIV PRESS, ISSN: 0007-1323
DeLago A, Essa M, Ghajar A, et al., 2021, Incidence and mortality trends of atrial fibrillation/atrial flutter in the United States 1990 to 2017, American Journal of Cardiology, Vol: 148, Pages: 78-83, ISSN: 0002-9149
Atrial fibrillation / Atrial fibrillation flutter incidence and mortality rate has increased in the United States. The greatest incidence rates for men in 2017 were clustered in the New England region. An inflection point in year 2001 is notable for increased incidence and mortality rates for both genders across most states.
Guni A, Machin M, Onida S, et al., 2021, Acute iliofemoral DVT – what evidence is required to justify catheter-directed thrombolysis?, Phlebology, Vol: 36, Pages: 339-341, ISSN: 0268-3555
COVIDSurg Collaborative, GlobalSurg Collaborative, 2021, Timing of surgery following SARS‐CoV‐2 infection: an international prospective cohort study, Anaesthesia, Vol: 76, Pages: 748-758, ISSN: 0003-2409
Peri‐operative SARS‐CoV‐2 infection increases postoperative mortality. The aim of this study was to determine the optimal duration of planned delay before surgery in patients who have had SARS‐CoV‐2 infection. This international, multicentre, prospective cohort study included patients undergoing elective or emergency surgery during October 2020. Surgical patients with pre‐operative SARS‐CoV‐2 infection were compared with those without previous SARS‐CoV‐2 infection. The primary outcome measure was 30‐day postoperative mortality. Logistic regression models were used to calculate adjusted 30‐day mortality rates stratified by time from diagnosis of SARS‐CoV‐2 infection to surgery. Among 140,231 patients (116 countries), 3127 patients (2.2%) had a pre‐operative SARS‐CoV‐2 diagnosis. Adjusted 30‐day mortality in patients without SARS‐CoV‐2 infection was 1.5% (95%CI 1.4–1.5). In patients with a pre‐operative SARS‐CoV‐2 diagnosis, mortality was increased in patients having surgery within 0–2 weeks, 3–4 weeks and 5–6 weeks of the diagnosis (odds ratio (95%CI) 4.1% (3.3–4.8), 3.9% (2.6–5.1) and 3.6% (2.0–5.2), respectively). Surgery performed ≥ 7 weeks after SARS‐CoV‐2 diagnosis was associated with a similar mortality risk to baseline (odds ratio (95%CI) 1.5% (0.9–2.1%)). After a ≥ 7 week delay in undertaking surgery following SARS‐CoV‐2 infection, patients with ongoing symptoms had a higher mortality than patients whose symptoms had resolved or who had been asymptomatic (6.0% (95%CI 3.2–8.7) vs. 2.4% (95%CI 1.4–3.4) vs. 1.3% (95%CI 0.6–2.0%), respectively). Where possible, surgery should be delayed for at least 7 weeks following SARS‐CoV‐2 infection. Patients with ongoing symptoms ≥ 7 weeks from diagnosis may benefit from further delay.
The Vascular and Endovascular Research Network VERN COVER Study Collaborative, Shalhoub J, 2021, Vascular surgery; a priority specialty or collateral damage in the face of a global pandemic? The persistent challenges faced by vascular surgery services during the UK coronavirus pandemic; a snapshot qualitative survey, Annals of the Royal College of Surgeons of England, ISSN: 0035-8843
Bergner R, Onida S, Velineni R, et al., 2021, Metabolic profiling reveals changes in serum predictive of venous ulcer healing, Annals of Surgery, ISSN: 0003-4932
Objective: The aim of this study was to identify potential biomarkers predictive of healing or failure to heal in a population with venous leg ulceration.Summary Background Data: Venous leg ulceration presents important physical, psychological, social and financial burdens. Compression therapy is the main treatment, but it can be painful and time-consuming, with significant recurrence rates. The identification of a reliable biochemical signature with the ability to identify nonhealing ulcers has important translational applications for disease prognostication, personalized health care and the development of novel therapies.Methods: Twenty-eight patients were assessed at baseline and at 20 weeks. Untargeted metabolic profiling was performed on urine, serum, and ulcer fluid, using mass spectrometry and nuclear magnetic resonance spectroscopy.Results: A differential metabolic phenotype was identified in healing (n = 15) compared to nonhealing (n = 13) venous leg ulcer patients. Analysis of the assigned metabolites found ceramide and carnitine metabolism to be relevant pathways. In this pilot study, only serum biofluids could differentiate between healing and nonhealing patients. The ratio of carnitine to ceramide was able to differentiate between healing phenotypes with 100% sensitivity, 79% specificity, and 91% accuracy.Conclusions: This study reports a metabolic signature predictive of healing in venous leg ulceration and presents potential translational applications for disease prognostication and development of targeted therapies.
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