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Abdallah N, Jani C, Mouchati C, et al., 2022, Trends of kidney cancer burden from 1990 to 2019 in European Union 15+countries., ASCO Genitourinary Cancers Symposium, Publisher: LIPPINCOTT WILLIAMS & WILKINS, ISSN: 0732-183X
Mouchati C, Abdallah N, Jani C, et al., 2022, Trends in disease burden from prostate cancer amongst different regions of the world and extensively the European Union 15+countries, from 1990 to 2019: Estimates from the Global Burden of Disease study., ASCO Genitourinary Cancers Symposium, Publisher: LIPPINCOTT WILLIAMS & WILKINS, ISSN: 0732-183X
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Jani C, Mouchati C, Abdallah N, et al., 2022, Trends in prostate cancer mortality in the United States of America, by state and race, from 1999 to 2019: Estimates from the Centers for Disease Control WONDER database., ASCO Genitourinary Cancers Symposium, Publisher: LIPPINCOTT WILLIAMS & WILKINS, ISSN: 0732-183X
Gradinariu G, Lyons O, Musajee M, et al., 2022, Predictors of percutaneous access-related complications in aortic endovascular procedures – 'real-world' insights and a comparison to open access. International Angiology 2022, International Angiology: a journal on angiology, ISSN: 0392-9590
Machin M, Younan H-C, Guéroult A, et al., 2022, Systematic review of inframalleolar endovascular interventions and rates of limb salvage, wound healing, restenosis, rest pain, reintervention and complications, Vascular, Vol: 30, Pages: 105-114, ISSN: 0967-2109
ObjectivesPeripheral artery disease is estimated to affect 237 million individuals worldwide. Critical limb ischaemia, also known as chronic limb threatening ischaemia is a consequence of the progression of peripheral artery disease which occurs in ∼21% of patients over a five-year period. The aim of this systematic review is to assess the use of additional below-the-ankle angioplasty in comparison to the use of above-the-ankle angioplasty alone, and the subsequent rates of amputation, wound healing, restenosis, rest pain, reintervention and complications.MethodsThis systematic review was undertaken in accordance with PRISMA guidelines following a registered protocol (CRD42019154893). Online databases were searched using a search strategy of 20 keywords. Included articles reported the outcome for inframalleolar (pedal artery, pedal arch, plantar arteries) angioplasty with additional proximal angioplasty in comparison to proximal angioplasty alone. GRADE assessment was applied to assess the quality of the evidence.ResultsAfter screening 1089 articles, 10 articles met the inclusion criteria. Comparative performance assessment of below-the-ankle with above-the-ankle versus above-the-ankle angioplasty alone was undertaken in 3 articles, with the remaining 7 articles reporting outcomes of below-the-ankle with above-the-ankle angioplasty with no distinct comparator group. Significant decrease in major lower limb amputation at the last follow-up in the below-the-ankle group when compared with the above-the-ankle angioplasty alone group was observed in a single study (3.45% vs. 14.9%, p < 0.05). Improved wound healing rate at follow-up in the below-the-ankle group versus above-the-ankle angioplasty alone group was also reported in a single study (59.3% vs. 38.1%, p < 0.05). Subsequent rate of amputation after below-the-ankle angioplasty has been estimated as 23.5%.ConclusionTo date, there is a lack of studies assessing inframalleolar in
Jani C, Salciccioli I, Rupal A, et al., 2022, Trends in Breast Cancer Mortality Between 2001 and 2017: An Observational Study in the European Union and the United Kingdom (vol 8, e2200015, 2022), JCO GLOBAL ONCOLOGY, Vol: 8
Hartley A, Pradeep M, Van den Berg V, et al., 2022, Depletion of homeostatic antibodies against malondialdehyde-modified low-density lipoprotein correlates with adverse events in major vascular surgery, Antioxidants, Vol: 11, ISSN: 2076-3921
We aimed to investigate if major vascular surgery induces LDL oxidation, and whether circulating antibodies against malondialdehyde-modified LDL (MDA-LDL) alter dynamically in this setting. We also questioned relationships between these biomarkers and post-operative cardiovascular events. Major surgery can induce an oxidative stress response. However, the role of the humoral immune system in clearance of oxidized LDL following such an insult is unknown. Plasma samples were obtained from a prospective cohort of 131 patients undergoing major non-cardiac vascular surgery, with samples obtained preoperatively and at 24- and 72 h postoperatively. Enzyme-linked immunoassays were developed to assess MDA-LDL-related antibodies and complexes. Adverse events were myocardial infarction (primary outcome), and a composite of unstable angina, stroke and all-cause mortality (secondary outcome). MDA-LDL significantly increased at 24 h post-operatively (p < 0.0001). Conversely, levels of IgG and IgM anti-MDA-LDL, as well as IgG/IgM-MDA-LDL complexes and total IgG/IgM, were significantly lower at 24 h (each p < 0.0001). A smaller decrease in IgG anti-MDA-LDL related to combined clinical adverse events in a post hoc analysis, withstanding adjustment for age, sex, and total IgG (OR 0.13, 95% CI [0.03–0.5], p < 0.001; p value for trend <0.001). Major vascular surgery resulted in an increase in plasma MDA-LDL, in parallel with a decrease in antibody/complex levels, likely due to antibody binding and subsequent removal from the circulation. Our study provides novel insight into the role of the immune system during the oxidative stress of major surgery, and suggests a homeostatic clearance role for IgG antibodies, with greater reduction relating to downstream adverse events.
DeLago AJ, Singh H, Jani C, et al., 2022, 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
Gimzewska M, Berthelot M, Sarai P, et al., 2022, Evaluation of a novel wireless near-infrared spectroscopy (NIRS) device in the detection of tourniquet induced ischaemia, BMJ Innovations, ISSN: 2055-8074
Schuster-Bruce J, Jani C, Goodall R, et al., 2022, A comparison of the burden of thyroid cancer between the European Union 15 countries, 1990-2019: estimates from the Global Burden of Disease Study, JAMA Otolaryngology-Head and Neck Surgery, ISSN: 2168-6181
Importance:The global incidence of thyroid cancer has been increasing rapidly and this has an attendant burden on health-systems. It is unclear how the burden of this disease differs between nations.Objective:To observe the trends in mortality, incidence and disability-adjusted life years (DALYs) from thyroid cancer between 1990-2019 in European Union (EU) 15+ nations.Design, Setting, Participants:Observational analysis using data obtained from the Global Burden of Disease (GBD) Study database. Countries of the EU15+ were included.Exposure:Thyroid cancer.Main Outcomes and Measures:Age-standarised incidence rates (ASIR), age-standardised mortality rates (ASMR) and disability-adjusted life years (DALYs) were extracted for individual EU15+ countries per sex for each of the years 1990-2019, and mortality-to-incidence indices (MII) were computed. Joinpoint regression analysis was used to describe the trends.Results:Thirteen of 19 countries showed an average annual percentage change (AAPC) increase in ASIR across the study period. Joinpoint regression analysis reveals largely plateauing ASIR trends in recent years across the majority of EU15+ nations since 1990. Australia, Belgium and the US are the only countries with increasing ASMR trends with positive AAPCs, whilst the remaining 16 countries show negative trends. DALYs decreased in all EU15+ countries except Australia, Denmark and the US. Conclusions and Relevance:Overall, the burden of thyroid cancer across EU15+ countries appears to be reducing, evidenced by plateauing incidence rates and reductions in mortality and DALYs over the 30-year study period. However, the US and Australia demonstrate unfavorable, increasing ASMR and DALY trends. Ongoing observation is required to monitor how changes in international clinical practice guidelines impact upon thyroid cancer DALYs and mortality.
Otunla A, Shanmugarajah K, Madariaga M, et al., 2022, Chronic rejection and atherosclerosis in post-transplant cardiovascular mortality: two sides of the same coin, Heart Lung and Circulation, Vol: 31, Pages: 162-166, 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.
Tabiri S, Kamarajah SK, Nepogodiev D, et al., 2022, Impact of Bacillus Calmette-Guerin (BCG) vaccination on postoperative mortality in patients with perioperative SARS-CoV-2 infection, BJS Open, Vol: 5, ISSN: 2474-9842
Houdmont J, Daliya P, Theophilidou E, et al., 2022, Burnout among surgeons in the United Kingdom during the COVID-19 pandemic: a cohort study, World Journal of Surgery, Vol: 46, Pages: 1-9, ISSN: 0364-2313
Background:Surgeon burnout has implications for patient safety and workforce sustainability. The aim of this study was to establish the prevalence of burnout among surgeons in the UK during the COVID-19 pandemic.MethodsThis cross-sectional online survey was set in the UK National Health Service and involved 601 surgeons across the UK of all specialities and grades. Participants completed the Maslach Burnout Inventory and a bespoke questionnaire. Outcome measures included emotional exhaustion, depersonalisation and low personal accomplishment, as measured by the Maslach Burnout Inventory-Human Services Survey (MBI-HSS).Results:A total of 142 surgeons reported having contracted COVID-19. Burnout prevalence was particularly high in the emotional exhaustion (57%) and depersonalisation (50%) domains, while lower on the low personal accomplishment domain (15%). Burnout prevalence was unrelated to COVID-19 status; however, the greater the perceived impact of COVID-19 on work, the higher the prevalence of emotional exhaustion and depersonalisation. Degree of worry about contracting COVID-19 oneself and degree of worry about family and friends contacting COVID-19 was positively associated with prevalence on all three burnout domains. Across all three domains, burnout prevalence was exceptionally high in the Core Trainee 1–2 and Specialty Trainee 1–2 grades.Conclusions:These findings highlight potential undesirable implications for patient safety arising from surgeon burnout. Moreover, there is a need for ongoing monitoring in addition to an enhanced focus on mental health self-care in surgeon training and the provision of accessible and confidential support for practising surgeons.
Taha M, Busuttil A, Bootun R, et al., 2022, A clinical guide to deep venous stenting for chronic iliofemoral venous obstruction, Journal of vascular surgery. Venous and lymphatic disorders, Vol: 10, Pages: 258-266.e1, ISSN: 2213-3348
BackgroundAn increase in endovenous interventions for deep venous pathologies has been observed. This article aims to provide an overview of the role of venous stenting in the management of chronic conditions affecting the deep venous system of the lower limbs, with a focus on intervention relating to the vena cava and iliofemoral venous segments.MethodsAn overview of the literature on the minimally invasive venous stenting procedures that are being increasingly used in the management of chronic conditions affecting the deep venous system of the lower limbs.ResultsWe discuss key areas of interest to a venous specialist practicing in this area, including diagnostic imaging in chronic deep venous disease, with a focus on the use of intravascular ultrasound examination in this context; the treatment of chronic venous outflow obstruction, including the rationale and structural indications for stenting, current guidance regarding stent placement, and fundamental points to consider during decision-making (endophlebectomy and stenting, stenting across the inguinal ligament, optimal sizing of venous stents, extension of venous stenting to beyond the common femoral vein confluence, the role of thrombolysis useful in chronic venous disease, and arteriovenous fistulae); outcomes and initial reports of stenting; and the future of venous stents.ConclusionsDeep venous stenting has become a key treatment option for chronic (thrombotic or nonthrombotic) obstructive venous disease. Dedicated venous stents and intravascular ultrasound examination represent important technological advances in the minimally invasive treatment of symptomatic chronic deep venous obstruction, which previously required open surgical reconstruction.
COVIDSurg Collaborative, GlobalSurg Collaborative, 2022, SARS‐CoV‐2 infection and venous thromboembolism after surgery: an international prospective cohort study, Anaesthesia, Vol: 77, Pages: 28-39, 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
Normahani P, Shalhoub J, 2022, Diabetic foot disease, Surgery (Oxford), Vol: 40, Pages: 53-61, ISSN: 0263-9319
Diabetic foot disease, or ulceration, is prevalent and is associated with high rates of lower limb amputation and mortality. Its underlying aetiology is complex and multifactorial. However, neuropathy and peripheral arterial disease represent two important precipitating risk factors. Regular, comprehensive foot examinations are important in the prevention of ulceration and cardiovascular complications as they provide an opportunity to assess risk, modify risk factors and deliver patient education. Charcot neuropathic osteoarthropathy is commonly misdiagnosed and should always be suspected in an individual with diabetes presenting with a hot and swollen foot. Diabetic foot ulcers are challenging to manage. The key to optimizing outcomes includes early diagnosis with referral for coordinated multidisciplinary care where prompt treatment of infection and peripheral arterial disease, as well as appropriate wound care and offloading can be initiated and monitored.
Jani C, Al Omari O, Singh H, et al., 2021, Trends of HIV-related cancer mortality between 2001 and 2018: an observational analysis, Tropical Medicine and Infectious Disease, Vol: 6, ISSN: 2414-6366
The burden of AIDS-defining cancers has remained relatively steady for the past two decades, whilst the burden of non-AIDS-defining cancer has increased. Here, we conduct a study to describe mortality trends attributed to HIV-associated cancers in 31 countries. We extracted HIV-related cancer mortality data from 2001 to 2018 from the World Health Organization Mortality Database. We computed age-standardized death rates (ASDRs) per 100,000 population using the World Standard Population. Data were visualized using Locally Weighted Scatterplot Smoothing (LOWESS). Data for females were available for 25 countries. Overall, there has been a decrease in mortality attributed to HIV-associated cancers among most of the countries. In total, 18 out of 31 countries (58.0%) and 14 out of 25 countries (56.0%) showed decreases in male and female mortality, respectively. An increasing mortality trend was observed in many developing countries, such as Malaysia and Thailand, and some developed countries, such as the United Kingdom. Malaysia had the greatest increase in male mortality (+495.0%), and Canada had the greatest decrease (-88.5%). Thailand had the greatest increase in female mortality (+540.0%), and Germany had the greatest decrease (-86.0%). At the endpoint year, South Africa had the highest ASDRs for both males (16.8/100,000) and females (19.2/100,000). The lowest was in Japan for males (0.07/100,000) and Egypt for females (0.028/100,000).
Jani C, Salcicciol I, Rupal A, et al., 2021, Trends in breast cancer mortality between 2001 and 2017: an observational study in the European Union and the United Kingdom., Jco Global Oncology, Vol: 7, Pages: 1682-1693, ISSN: 2687-8941
PURPOSE: 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, and newer modalities of treatment. Our study reports and compares trends in breast cancer mortality in the European Union and the United Kingdom. MATERIALS AND METHODS: We used the WHO Mortality Database. We extracted breast cancer mortality data from 2001 to 2017 on the basis of the International Classification of Diseases, 10th revision system. 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 EU countries, including the United Kingdom. For women, breast cancer mortality was observed to be downtrending 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 per 100,000), and the lowest ASDR was noted in Spain (12.8 per 100,000). Denmark had the highest change in ASDR and the highest estimated annual percentage change of -3.2%. For men, breast cancer mortality decreased in 18 countries, with the largest relative reduction observed in Denmark with an estimated annual percentage change of -27.5%. For the most recent male data, the highest ASDR for breast cancer was identified in Latvia (0.54 per 100,000). CONCLUSION: Breast cancer mortality rates have down trended in most EU countries between 2001 and 2017 for both men and women. 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.
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, Vol: 60, Pages: 1466-1474, ISSN: 1010-7940
<jats:title>Abstract</jats:title> <jats:sec> <jats:title> </jats:title> </jats:sec> <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 f
Khatri A, Davies A, Shalhoub J, 2021, Mechanical prophylaxis for venous thromboembolism prevention in obese individuals, Phlebology, Vol: 36, Pages: 768-770, ISSN: 0268-3555
Hitchman L, Nandhra S, Gooday C, et al., 2021, Tenotomy for diabetic foot ulcers: a scoping survey of current practice, Journal of Vascular Societies Great Britain and Ireland, Vol: 1, ISSN: 2754-0022
<jats:p>Background: Diabetes mellitus is one of the fastest growing health crises of our time. One of the major complications is diabetic foot ulcers, many of which fail to heal. Tenotomy – transection of tendon fibres – may help to redistribute pressure in the foot and therefore help ulcer healing and prevent recurrence. The aim of this survey was to explore the availability of pressure relieving adjuncts, including tenotomy, in diabetic foot services and interest in collaborating in further research studies. Methods: An online survey was performed of healthcare professionals involved in the management of diabetic foot ulcers to explore the multidisciplinary composition of diabetic foot services, offloading therapies available and interest in collaborating in further research. Results: The survey gained 168 responses from 10 countries. Most responders were orthopaedic surgeons (61.3%, 103/168). Of those who responded, 70.8% (119/168) had a dedicated diabetic foot clinic and 99 (58.9%) reported having an active tenotomy service. 73.8% (124/168) of responders wished to further collaborate and 82.1% (138/168) were willing to help involve their patients in a future trial. Conclusions: The results of this survey showed the variation in tenotomy practice and an appetite for collaborative research in this area. The Vascular Society of Great Britain and Ireland Diabetic Foot Specialist Interest Group will address these uncertainties through targeted collaborative research to investigate tenotomy as a potential clinical and cost-effective treatment in diabetic foot care.</jats:p>
Ghajar A, Essa M, Parvez A, et al., 2021, National Trends of Atrial Fibrillation/Atrial Flutter Mortality in the United States From 1999 to 2019: Regional, Racial, and Gender Variations, Annual Scientific Sessions of the American-Heart-Association / Resuscitation Science Symposium, Publisher: LIPPINCOTT WILLIAMS & WILKINS, ISSN: 0009-7322
Essa M, Ghajar A, DeLago A, et al., 2021, Age-Related Demographic Trends in Mortality Due to Ischemic Heart Disease in the United States From 1999 to 2019, Annual Scientific Sessions of the American-Heart-Association / Resuscitation Science Symposium, Publisher: LIPPINCOTT WILLIAMS & WILKINS, ISSN: 0009-7322
The Vascular and Endovascular Research Network, COVIDSurg Collaborative, Shalhoub J, 2021, Impact of COVID-19 on Vascular Patients Worldwide: Analysis of the COVIDSurg Data, The Journal of Cardiovascular Surgery: a journal on cardiac, vascular and thoracic surgery, ISSN: 0021-9509
Hartley A, Shalhoub J, Ng F, et al., 2021, Size matters in atrial fibrillation: the underestimated importance of reduction of contiguous electrical mass underlying the effectiveness of catheter ablation, Europace, Vol: 23, Pages: 1698-1707, ISSN: 1099-5129
Evidence has accumulated over the last century of the importance of a critical electrical mass in sustaining atrial fibrillation (AF). AF ablation certainly reduces electrically contiguous atrial mass, but this is not widely accepted to be an important part of its mechanism of action. In this article, we review data showing that atrial size is correlated in many settings with AF propensity. Larger mammals are more likely to exhibit AF. This is seen both in the natural world and in animal models, where it is much easier to create a goat model than a mouse model of AF, for example. This also extends to humans—athletes, taller people, and obese individuals all have large atria and are more likely to exhibit AF. Within an individual, risk factors such as hypertension, valvular disease and ischaemia can enlarge the atrium and increase the risk of AF. With respect to AF ablation, we explore how variations in ablation strategy and the relative effectiveness of these strategies may suggest that a reduction in electrical atrial mass is an important mechanism of action. We counter this with examples in which there is no doubt that mass reduction is less important than competing theories such as ganglionated plexus ablation. We conclude that, when considering future strategies for the ablative therapy of AF, it is important not to discount the possibility that contiguous electrical mass reduction is the most important mechanism despite the disappointing consequence being that enhancing success rates in AF ablation may involve greater tissue destruction.
Khatri C, Ward AE, Nepogodiev D, et al., 2021, Outcomes after perioperative SARS-CoV-2 infection in patients with proximal femoral fractures: an international cohort study, BMJ Open, Vol: 11, Pages: 1-10, ISSN: 2044-6055
Objectives Studies have demonstrated high rates of mortality in people with proximal femoral fracture and SARS-CoV-2, but there is limited published data on the factors that influence mortality for clinicians to make informed treatment decisions. This study aims to report the 30-day mortality associated with perioperative infection of patients undergoing surgery for proximal femoral fractures and to examine the factors that influence mortality in a multivariate analysis.Setting Prospective, international, multicentre, observational cohort study.Participants Patients undergoing any operation for a proximal femoral fracture from 1 February to 30 April 2020 and with perioperative SARS-CoV-2 infection (either 7 days prior or 30-day postoperative).Primary outcome 30-day mortality. Multivariate modelling was performed to identify factors associated with 30-day mortality.Results This study reports included 1063 patients from 174 hospitals in 19 countries. Overall 30-day mortality was 29.4% (313/1063). In an adjusted model, 30-day mortality was associated with male gender (OR 2.29, 95% CI 1.68 to 3.13, p<0.001), age >80 years (OR 1.60, 95% CI 1.1 to 2.31, p=0.013), preoperative diagnosis of dementia (OR 1.57, 95% CI 1.15 to 2.16, p=0.005), kidney disease (OR 1.73, 95% CI 1.18 to 2.55, p=0.005) and congestive heart failure (OR 1.62, 95% CI 1.06 to 2.48, p=0.025). Mortality at 30 days was lower in patients with a preoperative diagnosis of SARS-CoV-2 (OR 0.6, 95% CI 0.6 (0.42 to 0.85), p=0.004). There was no difference in mortality in patients with an increase to delay in surgery (p=0.220) or type of anaesthetic given (p=0.787).Conclusions Patients undergoing surgery for a proximal femoral fracture with a perioperative infection of SARS-CoV-2 have a high rate of mortality. This study would support the need for providing these patients with individualised medical and anaesthetic care, including medical optimisation before t
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, Vol: 5, Pages: 1-6, 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.
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.
Eves J, Sudarsanam A, Shalhoub J, et al., 2021, Augmented reality in vascular and endovascular surgery: a scoping review (Preprint)
<sec> <title>BACKGROUND</title> <p>Technological advances have transformed vascular intervention over recent decades. Augmented reality (AR) is a subject of growing interest within surgery, with potential to improve the clinicians’ understanding of 3D anatomy and their processing of real-time information. The aim of this review was to summarise the fundamental concepts of these technologies and to systematically assess the literature currently applying AR to vascular surgery.</p> </sec> <sec> <title>METHODS</title> <p>A systematic literature review of ‘Medline,’ ‘Scopus’ and ‘Embase’ was performed according to PRISMA guidelines. Studies were selected by a blinded process between two investigators and assessed with data quality tools.</p> </sec> <sec> <title>RESULTS</title> <p>AR technologies have had a number of applications across vascular and endovascular surgery. The majority of studies use 3D imaging (e.g) CT angiogram derived images of vascular anatomy to augment the clinicians anatomical understanding during procedures. A wide range of AR technologies have been employed with ‘heads up’ fusion imaging and AR head-mounted displays the most commonly clinically applied. AR applications have included guiding open, robotic and endovascular surgery while minimising dissection, improving procedural times and reducing radiation and contrast exposure. Additionally, AR has been successfully applied to surgical training, with scope to improve technical and team communication skills.</p> </sec> <sec> <title>CONCLUSIONS</t
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