Imperial College London

Dr Kapil Sugand

Faculty of MedicineDepartment of Surgery & Cancer

Honorary Clinical Research Fellow
 
 
 
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Contact

 

+44 (0)7773 642 813kapil.sugand04 Website

 
 
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Location

 

MSk LabCharing Cross HospitalCharing Cross Campus

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Summary

 

Publications

Publication Type
Year
to

73 results found

Sugand K, Aframian A, Park C, Sarraf KM, Collaborative COVERTet al., 2022, The impact of COVID-19 on acute trauma and orthopaedic referrals and surgery in the UK during the first wave of the pandemic: a multicentre observational study, BMJ Open, Vol: 12, ISSN: 2044-6055

Objective: This is the first British multi-centre study observing the impact of the COVID-19 pandemic on orthopaedic trauma with respect to referrals, operative caseload and mortality during its peak. Design: A longitudinal, multi-centre, retrospective, observational, cohort study was conducted during the peak 6 weeks of the first wave from March 17, 2020 compared to the same period in 2019. Setting: Hospitals from six major urban cities were recruited around the UK, including London.Participants: A total of 4840 clinical encounters were initially recorded. 4668 clinical encounters were analysed post-exclusion.Primary and secondary outcome measures: Primary outcomes included the number of acute trauma referrals and those undergoing operative intervention, mortality rates, and the proportion of patients contracting COVID-19. Secondary outcomes consisted of the mechanism of injury, type of operative intervention and proportion of aerosolising-generating anaesthesia utilised. Results: During the COVID-19 period there was a 34% reduction in acute orthopaedic trauma referrals compared to 2019 (1792 down to 1183 referrals), and 29.5% less surgical interventions (993 down to 700 operations). The mortality rate significantly (both statistically and substantially) more than doubled for both risk and odds ratios during the COVID period in all referrals (1.3% vs 3.8%, p=0.0005) and in those undergoing operative intervention (2.2% vs 4.9%, p=0.004). Moreover, mortality due to COVID-related complications (versus non-COVID causes) had greater odds by a factor of at least 20 times. For the operative cohort during COVID, there was a greater odds of aerosolising-generating anaesthesia (including those with superimposed regional blocks) by three-quarters as well as doubled odds of a Consultant acting as the primary surgeon. Conclusion: Although there was a reduction of acute trauma referrals and those undergoing operative intervention, the mortality rate still more than doubled in od

Journal article

Tabiri S, Kamarajah SK, Nepogodiev D, Li E, Simoes J, Sravanam S, Owusu SA, Mahama H, Agyeman YN, Arthur J, Kunfah SM, Gyamfi FE, Owusu EA, Loffler MW, Wandoh P, Bhangu A, Siaw-Acheampong K, Argus L, Chaudhry D, Dawson BE, Glasbey JC, Gujjuri RR, Jones CS, Khatri C, Keatley JM, Lawday S, Mann H, Marson EJ, Mclean KA, Picciochi M, Taylor EH, Tiwari A, Simoes JFF, Trout IM, Venn ML, Wilkin RJW, Dajti I, Gjata A, Boccalatte L, Modolo MM, Cox D, Pockney P, Townend P, Aigner F, Kronberger I, Hossain K, VanRamshorst G, Lawani I, Ataide G, Baiocchi G, Buarque I, Gohar M, Slavchev M, Agarwal A, Brar A, Martin J, Olivos M, Calvache J, Perez Rivera CJ, Hadzibegovic AD, Kopjar T, Mihanovic J, Klat J, Novysedlak R, Christensen P, El-Hussuna A, Batista S, Lincango E, Emile SH, Mengesha MG, Hailu DS, Tamiru H, Kauppila J, Arnaud A, Albertsmeiers M, Lederhuber H, Loffler M, Metallidis S, Tsoulfas G, Lorena MA, Grecinos G, Mersich T, Wettstein D, Ghosh D, Kembuan G, Brouk P, Khosravi M, Mozafari M, Adil A, Mohan HM, Zmora O, Fiore M, Gallo G, Pata F, Pellino G, Satoi S, Ayasra F, Chaar M, Fakhradiyev IR, Jamal M, Elhadi M, Gulla A, Roslani A, Martinez L, Ramos De la Medina A, Outani O, Jonker P, Kruijff S, Noltes M, Steinkamp P, van der Plas W, Ademuyiwa A, Osinaike B, Seyi-olajide J, Williams E, Pejkova S, Augestad KM, Soreide K, Al Balushi Z, Qureshi A, Sayyed R, Daraghmeh MAM, Abukhalaf S, Cukier M, Gomez H, Shu S, Vasquez X, Parreno-Sacdalan MD, Major P, Azevedo J, Cunha M, Santos I, Zarour A, Bonci E-A, Negoi I, Efetov S, Litvin A, Ntirenganya F, AlAmeer E, Radenkovic D, Xiang FKH, Hoe CM, Yong JNC, Moore R, Nhlabathi N, Colino RB, Bravo AM, Minaya-Bravo A, Jayarajah U, Wickramasinghe D, Elmujtaba M, Jebril W, Rutegard M, Sund M, Isik A, Leventoglu S, Abbott TEF, Benson R, Caruna E, Chakrabortee S, Demetriades A, Desai A, Drake TD, Edwards JG, Evans JP, Ford S, Fotopoulou C, Griffiths E, Hutchinson P, Jenkinson MD, Khan T, Knight S, Kolias A, Leung E, McKay S, Norman L, Ots Ret 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

Journal article

Morgan C, Sugand K, Ashdown T, Nathoo N, MacFarlane R, Dyke R, Park C, Aframian A, Domos P, Horwitz MD, Surgery DH, Sarraf KM, Dattani Ret al., 2022, Impact of the National Lockdown Due to the COVID-19 Pandemic On Upper Limb Trauma Workload in Central London: A Multi-Centre Longitudinal Observational Study During Implementation and Ease of National Lockdown, ARCHIVES OF BONE AND JOINT SURGERY-ABJS, Vol: 10, Pages: 23-31, ISSN: 2345-4644

Journal article

Hall AJ, Clement ND, Abdul-Jabar H, Abu-Rajab R, Abugarja A, Adam K, Aguado Hernández HJ, Améstica Lazcano G, Anderson S, Ansar M, Antrobus J, Aragón Achig EJ, Archunan M, Arrieta Salinas M, Ashford-Wilson S, Assens Gibert C, Athanasopoulou K, Awadelkarim M, Baird S, Bajada S, Balakrishnan S, Balasubramanian S, Ballantyne JA, Bárcena Goitiandia L, Barkham B, Barmpagianni C, Barres-Carsi M, Barrett S, Baskaran D, Bell J, Bell K, Bell S, Bellelli G, Benchimol JA, Boietti BR, Boswell S, Braile A, Brennan C, Brent L, Brooke B, Bruno G, Burahee A, Burns S, Calabrò G, Campbell L, Carabelli GS, Carnegie C, Carretero Cristobal G, Caruana E, Cassinello Ogea MAC, Castellanos Robles J, Castillon P, Chakrabarti A, Cecere AB, Chen P, Clarke JV, Collins G, Corrales Cardenal JE, Corsi M, Cózar Adelantado GM, Craxford S, Crooks M, Cuarental-García J, Cuthbert R, Dall G, Daskalakis I, De Cicco A, de la Fuente de Dios D, Demaria P, Dereix J, Díaz Jiménez J, Dinamarca Montecinos JL, Do Le HP, Donoso Coppa JP, Drosos G, Duffy A, East J, Eastwood D, Elbahari H, Elias de Molins Peña C, Elmamoun M, Emmerson B, Escobar Sánchez D, Faimali M, Farré-Mercadé MV, Farrow L, Fayez A, Fell A, Fenner C, Ferguson D, Finlayson L, Flores Gómez A, Freeman N, French J, Gabardo Calvo S, Gagliardo N, Garcia Albiñana J, García Cruz G, García de Cortázar Antolín U, García Virto Vet al., 2022, IMPACT-Global Hip Fracture Audit: Nosocomial infection, risk prediction and prognostication, minimum reporting standards and global collaborative audit: Lessons from an international multicentre study of 7,090 patients conducted in 14 nations during the COVID-19 pandemic, Surgeon, ISSN: 1479-666X

Aims: This international study aimed to assess: 1) the prevalence of preoperative and postoperative COVID-19 among patients with hip fracture, 2) the effect on 30-day mortality, and 3) clinical factors associated with the infection and with mortality in COVID-19-positive patients. Methods: A multicentre collaboration among 112 centres in 14 countries collected data on all patients presenting with a hip fracture between 1st March-31st May 2020. Demographics, residence, place of injury, presentation blood tests, Nottingham Hip Fracture Score, time to surgery, management, ASA grade, length of stay, COVID-19 and 30-day mortality status were recorded. Results: A total of 7090 patients were included, with a mean age of 82.2 (range 50–104) years and 4959 (69.9%) being female. Of 651 (9.2%) patients diagnosed with COVID-19, 225 (34.6%) were positive at presentation and 426 (65.4%) were positive postoperatively. Positive COVID-19 status was independently associated with male sex (odds ratio (OR) 1.38, p = 0.001), residential care (OR 2.15, p < 0.001), inpatient fall (OR 2.23, p = 0.003), cancer (OR 0.63, p = 0.009), ASA grades 4 (OR 1.59, p = 0.008) or 5 (OR 8.28, p < 0.001), and longer admission (OR 1.06 for each increasing day, p < 0.001). Patients with COVID-19 at any time had a significantly lower chance of 30-day survival versus those without COVID-19 (72.7% versus 92.6%, p < 0.001). COVID-19 was independently associated with an increased 30-day mortality risk (hazard ratio (HR) 2.83, p < 0.001). Increasing age (HR 1.03, p = 0.028), male sex (HR 2.35, p < 0.001), renal disease (HR 1.53, p = 0.017), and pulmonary disease (HR 1.45, p = 0.039) were independently associated with a higher 30-day mortality risk in patients with COVID-19 when adjusting for confounders. Conclusion: The prevalence of COVID-19 in hip fracture patients during the first wave of the pandemic was 9%, and was independently associated with a three-fold increased 30-day mortality

Journal article

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

Journal article

Bhattacharyya R, Al-Obaidi B, Sugand K, Bhattacharya R, Gupte CMet al., 2021, Evaluating the effectiveness of the Imperial Femoral Intramedullary Nailing Cognitive Task Analysis (IFINCTA) tool in a real-time simulation setting (Distributed Interactive Simulation): a randomized controlled trial, INJURY-INTERNATIONAL JOURNAL OF THE CARE OF THE INJURED, Vol: 52, Pages: 3420-3426, ISSN: 0020-1383

Journal article

Khatri C, Ward AE, Nepogodiev D, Ahmed I, Chaudhry D, Dhaif F, Bankhad-Kendall B, Kaafarani H, Bretherton C, Mahmood A, Marais L, Parsons N, Bhangu A, Metcalfe A, Parsons N, Khatri C, Siaw-Acheampong K, Chaudhry D, Dawson BE, Evans JP, Glasbey JC, Gujjuri RR, Heritage E, Jones CS, Kamarajah SK, Khatri C, Keatley JM, Lawday S, Li E, Mckay SC, Nepogodiev D, Pellino G, Tiwari A, Simoes JFF, Trout IM, Venn ML, Wilkin RJW, Bhangu A, Ademuyiwa AO, Agarwal A, Al Ameer E, Alderson D, Alser O, Arnaud AP, Augestad KM, Bankhead-Kendall B, Benson RA, Chakrabortee S, Blanco-Colino R, Brar A, Bravo AM, Breen KA, Buarque IL, Caruana E, Cunha MF, Davidson GH, Desai A, Di Saverio S, Edwards J, Elhadi M, Farik S, Fiore M, Fitzgerald JE, Ford S, Gallo G, Ghosh D, Gomes GMA, Griffiths E, Halkias C, Harrison EM, Hutchinson P, Isik A, Kaafarani H, Kolias A, Lawani I, Lederhuber H, Leventoglu S, Loffler MW, Martin J, Mashbari H, Mazingi D, Mohan H, Moore R, Moszkowicz D, Ng-Kamstra JS, Metallidis S, Moug S, Niquen M, Ntirenganya F, Outani O, Pata F, Pinkney TD, Pockney P, Radenkovic D, Ramos-De la Medina A, Roberts K, Santos I, Schache A, Schnitzbauer A, Stewart GD, Shaw R, Shu S, Soreide K, Spinelli A, Sundar S, Tabiri S, Townend P, Tsoulfas G, van Ramshorst G, Vidya R, Vimalachandran D, Wright N, Simoes JFF, Mak JKC, Kulkarni R, Sharma N, Nankivell P, Tirotta F, Parente A, Breik O, Kisiel A, Cato LD, Saeed S, Bhangu A, Griffiths E, Pathanki AM, Ford S, Desai A, Almond M, Kamal M, Chebaro A, Lecolle K, Truant S, El Amrani M, Zerbib P, Pruvot FR, Mathieu D, Surmei E, Mattei L, Marin H, Dudek J, Singhal T, El-Hasani S, Nehra D, Walters A, Cuschieri J, Davidson GH, Ho M, Wade RG, Johnstone J, Bourke G, Brunelli A, Elkadi H, Otify M, Pompili C, Burke JR, Bagouri E, Chowdhury M, Abual-Rub Z, Kaufmann A, Munot S, Lo T, Young A, Kowal M, Wall J, Peckham-Cooper A, Winter SC, Belcher E, Stavroulias D, Di Chiara F, Wallwork K, Qureishi A, Lami M, Sravanam S, Mastoridis S, Shah K, Chidambaram S, Smet 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

Journal article

Chan G, Narang A, Aframian A, Ali Z, Bridgeman J, Carr A, Chapman L, Goodier H, Morgan C, Park C, Sexton S, Sugand K, Walton T, Wilson M, Belgaumkar A, Gallagher K, Ghosh K, Gibbons C, Jacob J, Keightley A, Nawaz Z, Sarraf K, Wakeling C, Kieffer W, Rogers Bet al., 2021, Medium-term mortality after hip fractures and COVID-19: A prospective multi-centre UK study., Chin J Traumatol, ISSN: 1008-1275

PURPOSE: The COVID-19 pandemic has caused 1.4 million deaths globally and is associated with a 3 to 4 times increase in 30-day mortality after a fragility hip fracture with concurrent COVID-19 infection. Typically, death from COVID-19 infection occurs between 15 and 22 days after the onset of symptoms, but this period can extend up to 8 weeks. This study aimed to assess the impact of concurrent COVID-19 infection on 120-day mortality after a fragility hip fracture. METHODS: A multi-centre prospective study across 10 hospitals treating 8% of the annual burden of hip fractures in England between 1st March and 30th April, 2020 was performed. Patients whose surgical treatment was payable through the National Health Service Best Practice Tariff mechanism for "fragility hip fractures" were included in the study. Patients' 120-day mortality was assessed relative to their peri-operative COVID-19 status. Statistical analysis was performed using SPSS version 27. RESULTS: A total of 746 patients were included in this study, of which 87 (11.7%) were COVID-19 positive. Mortality rates at 30 and 120-day were significantly higher for COVID-19 positive patients relative to COVID-19 negative patients (p < 0.001). However, mortality rates between 31 and 120-day were not significantly different (p = 0.107), 16.1% and 9.4% respectively for COVID-19 positive and negative patients, odds ratio 1.855 (95% confidence interval 0.865-3.978). CONCLUSION: Hip fracture patients with concurrent COVID-19 infection, provided that they are alive at day-31 after injury, have no significant difference in 120-day mortality. Despite the growing awareness and concern of "long-COVID" and its widespread prevalence, this does not appear to increase medium-term mortality rates after a hip fracture.

Journal article

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

Journal article

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.

Journal article

Park C, Sugand K, Aframian A, Morgan C, Pakroo N, Gibbons C, Fertleman M, Nathwani D, Bhattacharya R, Sarraf KMet al., 2021, Impact of COVID-19 pandemic on hip fractures: the central London experience COVID-related urgent geriatric hip trauma (COUGH) study COVERT ( COVid Emergency-Related Trauma and orthopaedics) collaborative, Irish Journal of Medical Science, ISSN: 0021-1265

Introduction:COVID-19 has been recognized as the unprecedented global health crisis in modern times. The purpose of this study was to assess the impact of COVID-19 on treatment of neck of femur fractures (NOFF) against the current guidelines and meeting best practice key performance indicators (KPIs) according to the National Hip Fracture Database (NHFD) in two large central London hospitals.Materials and methodsA multi-center, longitudinal, retrospective, observational study of NOFF patients was performed for the first ‘golden’ month following the lockdown measures introduced in mid-March 2020. This was compared to the same time period in 2019.Results:A total of 78 cases were observed. NOFFs accounted for 11% more of all acute referrals during the COVID era. There were fewer overall breaches in KPIs in time to theatre in 2020 and also for those awaiting an orthogeriatric review. Time to discharge from the trust during the pandemic was improved by 54% (p < 0.00001) but patients were 51% less likely to return to their usual residence (p = 0.007). The odds ratio was significantly higher for consultant surgeon-led operations and consultant orthogeriatric-led review in the post-COVID era. There was no significant difference in using aerosol-generating anaesthetic procedures or immortality rates between both years.Conclusion:The impact of COVID-19 pandemic has not adversely affected the KPIs for the treatment of NOFF patients with significant improvement in numerous care domains. These findings may represent the efforts to ensure that these vulnerable patients are treated promptly to minimize their risks from the coronavirus.

Journal article

Ashdown T, Park C, Begum F, Panagiotidou A, Sugand K, El-Tawil Set al., 2021, Do Patients Accurately Represent Their Experiences After Hip and Knee Replacements?, CUREUS, Vol: 13

Journal article

Narang A, Chan G, Aframian A, Ali Z, Carr A, Goodier H, Morgan C, Park C, Sugand K, Walton T, Wilson M, Belgaumkar A, Gallagher K, Ghosh K, Gibbons C, Keightley A, Nawaz Z, Wakeling C, Sarraf K, Rogers BA, Kieffer WKMet al., 2020, Thirty-day mortality following surgical management of hip fractures during the COVID-19 pandemic: findings from a prospective multi-centre UK study (Aug, 10.1007/s00264-020-04739-y, 2020), INTERNATIONAL ORTHOPAEDICS, Vol: 44, Pages: 2819-2819, ISSN: 0341-2695

Journal article

Narang A, Chan G, Aframian A, Ali Z, Carr A, Goodier H, Morgan C, Park C, Sugand K, Walton T, Wilson M, Belgaumkar A, Gallagher K, Ghosh K, Gibbons C, Keightley A, Nawaz Z, Wakeling C, Sarraf K, Rogers BA, Kieffer WKMet al., 2020, Thirty-day mortality following surgical management of hip fractures during the COVID-19 pandemic: findings from a prospective multi-centre UK study, International Orthopaedics, Vol: 45, Pages: 23-31, ISSN: 0341-2695

PurposeThirty-day mortality of patients with hip fracture is well researched and predictive; validated scoring tools have been developed (Nottingham Hip Fracture Score, NHFS). COVID-19 has significantly greater mortality in the elderly and comorbid patients which includes hip fracture patients. Non-operative treatment is not appropriate due to significantly higher mortality, and therefore, these patients are often exposed to COVID-19 in the peri-operative period. What is unclear is the effect of concomitant COVID-19 infection in these patients.MethodsA multicentre prospective study across ten sites in the United Kingdom (responsible for 7% of hip fracture patients per annum in the UK). Demographic and background information were collected by independent chart review. Data on surgical factors included American Society of Anesthesiologists (ASA) score, time to theatre, Nottingham Hip fracture score (NHFS) and classification of fracture were also collected between 1st March 2020 and 30th April 2020 with a matched cohort from the same period in 2019.ResultsActual and expected 30-day mortality was found to be significantly higher than expected for 2020 COVID-19 positive patients (RR 3.00 95% CI 1.57–5.75, p < 0.001), with 30 observed deaths compared against the 10 expected from NHFS risk stratification.ConclusionCOVID-19 infection appears to be an independent risk factor for increased mortality in hip fracture patients. Whilst non-operative management of these fractures is not suggested due to the documented increased risks and mortality, this study provides evidence to the emerging literature of the severity of COVID-19 infection in surgical patients and the potential impact of COVID-19 on elective surgical patients in the peri-operative period.

Journal article

Sugand K, Park C, Morgan C, Dyke R, Aframian A, Hulme A, Evans S, Sarraf KMet al., 2020, Impact of the COVID-19 pandemic on paediatric orthopaedic trauma workload in central London: a multi-centre longitudinal observational study over the "golden weeks" The COVid Emergency Related Trauma and orthopaedics (COVERT) Collaborative, Acta Orthopaedica, Vol: 91, Pages: 633-638, ISSN: 0001-6470

Background and purpose — The COVID-19 pandemic has been recognised as an unprecedented global health crisis. This study assesses the impact on a large acute paediatric hospital service in London, evaluating the trends in the acute paediatric orthopaedic trauma referral caseload and operative casemix before (2019) and during (2020) COVID-19 lockdown.Patients and methods — A longitudinal retrospective observational prevalence study of both acute paediatric orthopaedic trauma referrals and operative caseload was performed for the first 6 “golden weeks” of lockdown. These data were compared with the same period in 2019. Statistical analyses included median (± median absolute deviation), risk and odds ratios as well as Fisher’s exact test to calculate the statistical significance, set at p ≤ 0.05.Results — Acute paediatric trauma referrals in 2020 were reduced by two-thirds compared with 2019 (n = 302 vs. 97) with a halving risk (RR 0.55) and odds ratios (OR 0.43) of sporting-related mechanism of injuries (p = 0.002). There was a greater use of outpatient telemedicine in the COVID-19 period with more Virtual Fracture Clinic use (OR 97, RR 84, p < 0.001), and fewer patients being seen for consultation and followed up face to face (OR 0.55, RR 0.05, p < 0.001).Interpretation — The impact of the COVID-19 pandemic has led to a decline in the number of acute paediatric trauma referrals, admissions, and operations during the COVID period. There has also been a significant change in the patient pathway with more being reviewed via the means of telemedicine to reduce the risk of COVID-19 transmission and exposure. More work is required to observe for similar trends nationwide and globally as the pandemic has permanently affected the entire healthcare infrastructure.

Journal article

Park C, Sugand K, Nathwani D, Bhattacharya R, Sarraf KMet al., 2020, Impact of the COVID-19 pandemic on orthopedic trauma workload in a London level 1 trauma center: the "golden month" The COVid Emergency Related Trauma and orthopaedics (COVERT) Collaborative, ACTA ORTHOPAEDICA, Vol: 91, Pages: 556-561, ISSN: 1745-3674

Journal article

Tsang CLN, Cao J, Sugand K, Chiu J, Pretorius FCet al., 2020, Face, content, construct validity and training effect of touch surgery (TM) as a surgical decision-making trainer for novices in open appendicectomy, INTERNATIONAL JOURNAL OF SURGERY PROTOCOLS, Vol: 22, Pages: 19-23, ISSN: 2468-3574

Journal article

Wang H, Lyu F, Sugand K, Wong S, Lin Y, Wang Qet al., 2019, Learning Acetabular Fracture Classification using a Three-Dimensional Interactive Software: A Randomized Controlled Trial, ANATOMICAL SCIENCES EDUCATION, Vol: 12, Pages: 655-663, ISSN: 1935-9772

Journal article

Sugand K, Wescott RA, Carrington R, Hart A, van Duren BHet al., 2019, Training and Transfer Effect of FluoroSim, an Augmented Reality Fluoroscopic Simulator for Dynamic Hip Screw Guidewire Insertion A Single-Blinded Randomized Controlled Trial, JOURNAL OF BONE AND JOINT SURGERY-AMERICAN VOLUME, Vol: 101, ISSN: 0021-9355

Journal article

Adebayo O, Sugand K, 2019, Cognitive Task Mobile Application Simulation for Learning Anterior Cruciate Ligament Reconstruction Surgery, International Surgical Conference of the Association-of-Surgeons-in-Training (ASIT), Publisher: WILEY, Pages: 8-8, ISSN: 0007-1323

Conference paper

Sugand K, Malik HH, Newman S, Spicer D, Reilly P, Gupte CMet al., 2019, Does using anatomical models improve patient satisfaction in orthopaedic consenting? Single-blinded randomised controlled trial, SURGEON-JOURNAL OF THE ROYAL COLLEGES OF SURGEONS OF EDINBURGH AND IRELAND, Vol: 17, Pages: 146-155, ISSN: 1479-666X

Journal article

Sugand K, Berry M, Yusuf I, Bird C, Janjua A, Thrumurthy Set al., 2019, Oxford Handbook for Medical School, Publisher: Oxford University Press, USA, ISBN: 9780199681907

This handbook includes quick-access summaries covering the crucial information for your preclinical years and for each clinical specialty.

Book

Wang H, Sugand K, Newman S, Jones G, Cobb J, Auvinet Eet al., 2019, Are multiple views superior to a single view when teaching hip surgery? A single-blinded randomized controlled trial of technical skill acquisition, PLoS ONE, Vol: 14, ISSN: 1932-6203

s Metrics Comments Media Coverage Abstract Introduction Materials and methods Results Discussion Conclusion Supporting information References Reader Comments (0) Media Coverage (0) FiguresAbstractPurposeSurgical education videos currently all use a single point of view (POV) with the trainee locked onto a fixed viewpoint, which may not deliver sufficient information for complex procedures. We developed a novel multiple POV video system and evaluated its training outcome compared with traditional single POV.MethodsWe filmed a hip resurfacing procedure performed by an expert attending using 8 cameras in theatre. 30 medical students were randomly and equally allocated to learn the procedure using the multiple POV (experiment group [EG]) versus single POV system (control group [CG]). Participants advanced a pin into the femoral head as demonstrated in the video. We measured the drilling trajectories and compared it with pre-operative plan to evaluate distance of the pin insertion and angular deviations. Two orthopedic attendings expertly evaluated the participants’ performance using a modified global rating scale (GRS). There was a pre-video knowledge test that was repeated post-simulation alongside a Likert-scale questionnaire.ResultsThe angular deviation of the pin in EG was significantly less by 29% compared to CG (p = 0.037), with no significant difference in the entry point’s distance between groups (p = 0.204). The GRS scores for EG were 3.5% higher than CG (p = 0.046). There was a 32% higher overall knowledge test score (p<0.001) and 21% improved Likert-scale questionnaire score (p = 0.002) after video-learning in EG than CG, albeit no significant difference in the knowledge test score before video-learning (p = 0.721).ConclusionThe novel multiple POV provided significant objective and subjective advantages over single POV for acquisition of technical skills in hip surgery.

Journal article

Bhattacharyya R, Davidson DJ, Sugand K, Akhbari P, Bartlett MJ, Bhattacharya R, Gupte CMet al., 2018, Knee Arthroscopy: A Simulation Demonstrating the Imperial Knee Arthroscopy Cognitive Task Analysis (IKACTA) Tool., JBJS Essent Surg Tech, Vol: 8, Pages: e32-e32, ISSN: 2160-2204

Background: Virtual reality and cadaveric simulations are expensive and not readily accessible1. Innovative and accessible training adjuncts are required to help meet training needs. Cognitive task analysis (CTA) has been used extensively to train pilots and surgeons in other surgical specialties2-6. However, the use of CTA tools within orthopaedics is in its infancy. Arthroscopic procedures are minimally invasive and require a different skill set compared with open surgery. Residents often feel poorly prepared to perform this in the operating room because of the steep learning curve associated with acquiring basic arthroscopic skills. We designed the Imperial Knee Arthroscopy Cognitive Task Analysis (IKACTA) tool, which is, to our knowledge, the first CTA tool described in the orthopaedic literature, demonstrating significant objective benefits in training novices to perform diagnostic knee arthroscopy. Description: The IKACTA tool, which is the combination of the written description of the phases below and the videos (with superimposed audio recordings) of each phase, utilizes simultaneous written and audiovisual modalities to teach diagnostic knee arthroscopy. The procedure was divided into 7 phases: (1) operating room and patient setup, (2) preparation and draping, (3) anterolateral portal placement, (4) examination of the patellofemoral joint and the lateral gutter, (5) examination of the medial compartment and anteromedial portal placement, (6) examination of the intercondylar notch and the lateral compartment, and (7) postoperative care and rehabilitation.For each phase, there are sections on the technical steps, cognitive decision-making behind each technical step, and potential errors and solutions. Video clips recorded by an expert surgeon in the operating room specific to each phase and audio voice recordings explaining each phase superimposed on the video clips were combined with the written information to design the IKACTA tool. Alternatives: Not applic

Journal article

Bhattacharyya R, Sugand K, Al-Obaidi B, Sinha I, Bhattacharya R, Gupte CMet al., 2018, Trauma simulation training: a randomized controlled trial -evaluating the effectiveness of the Imperial Femoral Intramedullary Nailing Cognitive Task Analysis (IFINCTA) tool, Acta Orthopaedica, Vol: 89, Pages: 689-695, ISSN: 1745-3674

Background and purpose - Cognitive task analysis (CTA) has been used extensively to train pilots and in other surgical specialties. However, the use of CTA within orthopedics is in its infancy. We evaluated the effectiveness of a novel CTA tool to improve understanding of the procedural steps in antegrade femoral intramedullary nailing. Material and methods - Design: A modified Delphi technique was used to generate a CTA from 3 expert orthopedic trauma surgeons for antegrade femoral intramedullary nailing. The written and audiovisual information was combined to describe the technical steps, decision points, and errors for each phase of this procedure Validation: A randomized double-blind controlled trial was undertaken with 22 medical students (novices) randomized into 2 equal groups. The intervention group were given the CTA tool and the control group were given a standard operative technique manual. They were assessed using the validated "Touch Surgery™" application assessment tool on femoral intramedullary nailing. Results - The pre-test scores between the two groups were similar. However, the post-test scores were statistically significantly better in the intervention group compared with the control group. The improvement (post-test median scores) in the intervention group compared with the control group was 20% for patient positioning and preparation, 21% for femoral preparation, 10% for proximal locking, and 19% for distal locking respectively (p < 0.001 for all comparisons). Interpretation - This is the first multimedia CTA tool in femoral intramedullary nailing that is easily accessible, user-friendly, and has demonstrated significant benefits in training novices over the traditional use of operative technique manuals.

Journal article

Sugand K, Gupte CM, 2018, ABC of Orthopaedics and Trauma, Publisher: John Wiley & Sons, ISBN: 9781118561218

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Book

Sugand K, Wescott RA, Carrington R, Hart A, Van Duren BHet al., 2018, Teaching basic trauma: validating FluoroSim, a digital fluoroscopic simulator for guide-wire insertion in hip surgery., Acta Orthopaedica, Vol: 89, Pages: 1-6, ISSN: 1745-3674

Background and purpose - Simulation is an adjunct to surgical education. However, nothing can accurately simulate fluoroscopic procedures in orthopedic trauma. Current options for training with fluoroscopy are either intraoperative, which risks radiation, or use of expensive and unrealistic virtual reality simulators. We introduce FluoroSim, an inexpensive digital fluoroscopy simulator without the need for radiation. Patients and methods - This was a multicenter study with 26 surgeons in which everyone completed 1 attempt at inserting a guide-wire into a femoral dry bone using surgical equipment and FluoroSim. 5 objective performance metrics were recorded in real-time to assess construct validity. The surgeons were categorized based on the number of dynamic hip screws (DHS) performed: novices (< 10), intermediates (10-39) and experts (≥ 40). A 7-point Likert scale questionnaire assessed the face and content validity of FluoroSim. Results - Construct validity was present for 2 clinically validated metrics in DHS surgery. Experts and intermediates statistically significantly outperformed novices for tip-apex distance and for cut-out rate. Novices took the least number of radiographs. Face and content validity were also observed. Interpretation - FluoroSim discriminated between novice and intermediate or expert surgeons based on tip-apex distance and cut-out rate while demonstrating face and content validity. FluoroSim provides a useful adjunct to orthopedic training. Our findings concur with results from studies using other simulation modalities. FluoroSim can be implemented for education easily and cheaply away from theater in a safe and controlled environment.

Journal article

van Duren BH, Sugand K, Wescott R, Carrington R, Hart Aet al., 2018, Augmented reality fluoroscopy simulation of the guide-wire insertion in DHS surgery: A proof of concept study, MEDICAL ENGINEERING & PHYSICS, Vol: 55, Pages: 52-59, ISSN: 1350-4533

Journal article

Gupte CM, 2017, Knee Arthroscopy SimulationA Randomized Controlled Trial Evaluating the Effectiveness of the Imperial Knee Arthroscopy Cognitive Task Analysis (IKACTA) Tool, Journal of Bone and Joint Surgery, American Volume, ISSN: 0021-9355

Journal article

Metcalfe D, Sugand K, Thrumurthy SG, Thompson MM, Holt PJ, Karthikesalingam APet al., 2016, Diagnosis of ruptured abdominal aortic aneurysm: a multicentre cohort study, EUROPEAN JOURNAL OF EMERGENCY MEDICINE, Vol: 23, Pages: 386-390, ISSN: 0969-9546

Journal article

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