Publications
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Burns EM, Bottle A, Aylin P, et al., 2010, National outcomes following bariatric surgery in England, Electronic Poster of Distinction in Association-of-Surgeons-of-Great-Britain-and-Ireland-International-Surgical-Congress, Publisher: WILEY-BLACKWELL, Pages: 8-8, ISSN: 0007-1323
Burns EM, Faiz O, 2010, Evolution of the surgeon--volume, patient outcome relationship, Annals of surgery, Vol: 251, Pages: 991-992, ISSN: 1528-1140
Burns E, Naseem H, Aylin P, et al., 2010, Trends in laparoscopic bariatric surgery and comparisons of outcomes with open surgery: a national study in England 2000-2008, Electronic Poster of Distinction in Association-of-Surgeons-of-Great-Britain-and-Ireland-International-Surgical-Congress, Publisher: WILEY-BLACKWELL, Pages: 40-40, ISSN: 0007-1323
Almoudaris A, Burns E, Bottle A, et al., 2010, Do surgical units that submit data to a voluntary national colorectal cancer registry have better outcomes than those that do not?, Electronic Poster of Distinction in Association-of-Surgeons-of-Great-Britain-and-Ireland-International-Surgical-Congress, Publisher: WILEY-BLACKWELL, Pages: 43-43, ISSN: 0007-1323
Burns EM, Bottle A, Aylin P, et al., 2010, National outcomes following restorative proctocolectomy in England, Electronic Poster of Distinction in Association-of-Surgeons-of-Great-Britain-and-Ireland-International-Surgical-Congress, Publisher: WILEY-BLACKWELL, Pages: 72-72, ISSN: 0007-1323
Faiz O, Warusavitarne J, Bottle A, et al., 2010, Nonelective excisional colorectal surgery in English National Health Service Trusts: a study of outcomes from Hospital Episode Statistics Data between 1996 and 2007, Journal of the American College of Surgeons, Vol: 210, Pages: 390-401, ISSN: 1879-1190
BACKGROUND: Nonelective colorectal surgery is associated with substantial patient morbidity and mortality. This study sought to describe the practice of emergency colorectal surgery in the United Kingdom during an 11-year period using the Hospital Episode Statistics (HES) database. STUDY DESIGN: All nonelective admissions in patients undergoing 1 of 8 colorectal resectional procedures between 1996 and 2007 were included. Time trends, univariate, and multivariate mortality and length of stay outcomes were analyzed. RESULTS: A total of 102,236 major urgent/emergency procedures were performed in English National Health Service Trusts between April 1996 and March 2007. Thirty-day in-hospital postoperative mortality rates in patients with colorectal cancer and diverticular disease were 13.3% and 15.4%, respectively. The corresponding 1-year postoperative mortality was 34.7% and 22.6%. On multivariate analysis, benign diagnosis, advanced age, high comorbidity score, social deprivation, and specific procedure types were independent predictors of early and 1-year postoperative mortality (p < 0.001). Independent risk factors for extended hospital stay were advanced age, social deprivation, distal (compared with proximal) bowel resection, and a diagnosis of ulcerative colitis (p < 0.001). CONCLUSIONS: HES data suggest that in everyday practice, postoperative mortality among patients undergoing nonelective admission followed by colorectal resection is high. Additional investigation is required to assess the reliability of HES data for monitoring institutional variation in this context.
Faiz O, Brown T, Bottle A, et al., 2010, Impact of hospital institutional volume on postoperative mortality after major emergency colorectal surgery in English National Health Service Trusts, 2001 to 2005, Diseases of the colon and rectum, Vol: 53, Pages: 393-401, ISSN: 1530-0358
PURPOSE: The aim of this study was to investigate the effects of institutional volume on postoperative mortality in patients undergoing emergency major colorectal surgical procedures in England between 2001 and 2005. METHODS: All of the emergency excisional colorectal procedures performed between the above dates were included from the Hospital Episode Statistics data set. Institutions were divided into high-, medium-, and low-volume tertiles according to the total major emergency colorectal caseload. RESULTS: During the study period, 37,094 emergency excisional colorectal procedures were performed in 166 English National Health Service institutions. Overall 30-day postoperative mortality was 15.49%, increasing to 29.18% at 1 year after surgery. Overall 30- and 365-day mortality rates were similar among institutional volume tertiles (P > .05) after adjustment for age, sex, social deprivation, diagnosis, procedure type, and comorbidity score. CONCLUSION: Hospital Episode Statistics data suggest that institutions with high volumes of emergency colorectal caseload do not demonstrate lower mortality after emergency major excisional colorectal surgery.
Burns E, Bottle A, Faiz O, et al., 2010, The role of volume in bariatric surgery, Electronic Poster of Distinction in Association-of-Surgeons-of-Great-Britain-and-Ireland-International-Surgical-Congress, Publisher: WILEY-BLACKWELL, Pages: 72-72, ISSN: 0007-1323
Burns E, Bottle A, Aylin P, et al., 2010, Examining differences in case selection between surgeons with differing surgical caseload in pouch surgery, Electronic Poster of Distinction in Association-of-Surgeons-of-Great-Britain-and-Ireland-International-Surgical-Congress, Publisher: WILEY-BLACKWELL, Pages: 131-131, ISSN: 0007-1323
Nagpal K, Jeyarajah S, Faiz O, 2010, Re: Use of Hartmann's procedure in England. Colorectal Dis, 11: 308-12. Hartmann's reversal: is it a true figure?, Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland, Vol: 12, Pages: 153-154, ISSN: 1463-1318
Almoudaris A, Faiz O, 2010, Response to Thompson et al.: National Bowel Cancer Audit, Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland, Vol: 12, Pages: 948-950, ISSN: 1463-1318
Burns EM, Faiz O, 2010, Response to Khani et al., centralization of rectal cancer surgery improves long-term survival, Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland, Vol: 12, ISSN: 1463-1318
Burns EM, Bottle A, Aylin P, et al., 2010, Examining differences in postoperative outcomes between hospitals with differing surgical caseload following restorative proctocolectomy, Electronic Poster of Distinction in Association-of-Surgeons-of-Great-Britain-and-Ireland-International-Surgical-Congress, Publisher: WILEY-BLACKWELL, Pages: 133-133, ISSN: 0007-1323
Garcia-Granero E, Faiz O, Munoz E, et al., 2009, Macroscopic Assessment of Mesorectal Excision in Rectal Cancer A Useful Tool for Improving Quality Control in a Multidisciplinary Team, CANCER, Vol: 115, Pages: 3400-3411, ISSN: 0008-543X
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Burns EM, Mayer EK, Faiz O, 2009, Surgeon Volume Does Not Predict Outcomes in the Setting of Technical Credentialing: Results From a Randomized Trial of Colon Cancer, ANNALS OF SURGERY, Vol: 249, Pages: 866-866, ISSN: 0003-4932
Faiz OD, Bottle A, Aylin P, 2009, Is Laparoscopic Appendectomy Associated with Better Outcomes? <i>Reply</i>, ANNALS OF SURGERY, Vol: 249, Pages: 867-868, ISSN: 0003-4932
Faiz O, Brown T, Colucci G, et al., 2009, A cohort study of results following elective colonic and rectal resection within an enhanced recovery programme, Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland, Vol: 11, Pages: 366-372, ISSN: 1463-1318
OBJECTIVE: The use of laparoscopic surgery coupled with an enhanced recovery programme (ERP) has resulted in hospital stays of 4 or less days for colonic and 6 days following rectal resection, in previously reported small selected groups of patients. This report analyses an unselected cohort to determine if such benefits are reproducible. METHOD: Consecutive patients undergoing elective colonic or rectal surgery at a single centre between January 2002 and January 2006 were followed. All were included in the ERP and underwent either laparoscopic or open surgery. RESULTS: The study group comprised 241 patients (mean age of 67 +/- standard deviation 14 years and 49% male sex distribution) who underwent elective colorectal resection within the context of an ERP. One hundred and fifty-one (62.7%) patients had malignant disease. Overall, 191 (79.3%) patients underwent a laparoscopic procedure and the remaining underwent an open operation. Postoperative stay was shorter in patients undergoing laparoscopic vs open, colonic surgery (4 days vs 6 days, P = 0.002). A nonsignificant trend towards reduced postoperative stay was observed for patients undergoing laparoscopic vs open, rectal surgery (6 days vs 9 days, P = 0.088). Patients undergoing laparoscopic colectomy demonstrated significantly lower 30-day mortality rates than those undergoing traditional colectomy (3/131 vs 3/39, P = 0.049). CONCLUSION: Laparoscopic colonic surgery in the context of an ERP offers reduced hospital stay and may confer a survival advantage over traditional techniques. These results confirm that previously reported benefits of laparoscopic surgery are reproducible within an unselected population.
Jeyarajah S, Faiz O, Bottle A, et al., 2009, Diverticular disease hospital admissions are increasing, with poor outcomes in the elderly and emergency admissions, Alimentary pharmacology & therapeutics, Vol: 30, Pages: 1171-1182, ISSN: 1365-2036
BACKGROUND: Diverticular disease has a changing disease pattern with limited epidemiological data. AIM: To describe diverticular disease admission rates and associated outcomes through national population study. METHODS: Data were obtained from the English 'Hospital Episode Statistics' database between 1996 and 2006. Primary outcomes examined were 30-day overall and 1-year mortality, 28-day readmission rates and extended length of stay (LOS) beyond the 75th percentile (median inpatient LOS = 6 days). Multiple logistic regression analysis was used to determine independent predictors of these outcomes. RESULTS: Between the study dates 560 281 admissions with a primary diagnosis of diverticular disease were recorded in England. The national admission rate increased from 0.56 to 1.20 per 1000 population/year. 232 047 (41.4%) were inpatient admissions and, of these, 55 519 (23.9%) were elective and 176 528 (76.1%) emergency. Surgery was undertaken in 37 767 (16.3%). The 30-day mortality was 5.1% (n = 6735) and 1-year mortality was 14.5% (n = 11 567). The 28-day readmission rate was 9.6% (n = 21 160). Increasing age, comorbidity and emergency admission were independent predictors of all primary outcomes. CONCLUSIONS: Diverticular disease admissions increased over the course of the study. Patients of increasing age, admitted as emergency and significant comorbidity should be identified, allowing management modification to optimize outcomes.
Faiz O, Kennedy R, 2009, The cost of laparoscopic colorectal surgery, Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland, Vol: 11, Pages: 431-432, ISSN: 1463-1318
Garcia-Granero E, Sanahuja A, Garcia-Botello SA, et al., 2009, The ideal lateral internal sphincterotomy: clinical and endosonographic evaluation following open and closed internal anal sphincterotomy, Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland, Vol: 11, Pages: 502-507, ISSN: 1463-1318
OBJECTIVE: To evaluate the relationship between extent of internal sphincter division following open and closed sphincterotomy, as assessed by anal endosonography, with fissure persistence/recurrence and faecal incontinence. METHOD: A total of 140 consecutive patients undergoing lateral internal sphincterotomy (LIS) for idiopathic chronic anal fissure were prospectively studied. Preoperative clinical assessment was performed together with a postoperative clinical and endosonographic examination. Three zones of the internal sphincter, identifiable by endosonography, were used to describe the uppermost extent of LIS. Primary end-points were fissure persistence/recurrence and faecal incontinence. RESULTS: A total of 140 patients, median age 49.5 years (IQR: 38-56 years) were included. Seventy-five (53.6%) and 65(46.4%) patients underwent percutaneous LIS (PLIS) and open LIS (OLIS) respectively. Median follow-up was 21 months (IQR: 14-29 months). Persistence and recurrence rates were 2.9% (4/140) and 5.7% (8/140) respectively. 7.9% (11/140) patients scored > 3 on the Jorge and Wexner Faecal Incontinence scale. PLIS was associated with a trend towards higher fissure persistence/recurrence rates than OLIS (12.0%vs 4.6%, P = 0.141). OLIS was significantly associated with a higher proportion of complete sphincterotomies (CS) than PLIS (56/65 vs 48/75, P = 0.003). A CS was associated with a lower fissure persistence or recurrence rate (1/104 vs 11/36, P < 0.001) but higher incontinence scores (11/104 vs 0/36 cases with Wexner scores > 3, P = 0.042) than following incomplete sphincterotomy. There was a strongly significant increase in incontinence scores (P < 0.001) and decrease in recurrence rates (P < 0.001) with increasing length of sphincterotomy. CONCLUSION: We recommend a short and CS using either PLIS or OLIS for the treatment of idiopathic anal fissure.
Faiz O, Warusavitarne J, Bottle A, et al., 2009, Laparoscopically assisted vs. open elective colonic and rectal resection: a comparison of outcomes in English National Health Service Trusts between 1996 and 2006, Diseases of the colon and rectum, Vol: 52, Pages: 1695-1704, ISSN: 1530-0358
PURPOSE: This study was designed to compare outcomes after elective laparoscopic and conventional colorectal surgery over a ten-year period using data from the English National Health Service Hospital Episode Statistics database. METHODS: All elective colonic and rectal resections carried out in English Trusts between 1996 and 2006 were included. Univariate and multivariate analyses were used to compare 30 and 365-day mortality rates, 28-day readmission rates, and length of stay between laparoscopic and open surgery. RESULTS: Between the study dates 3,709 of 192,620 (1.9%) elective colonic and rectal resections were classified as laparoscopically assisted procedures. The 30-day and 365-day mortality rates were lower after laparoscopic resection than after open surgery (P < 0.05). After correction for age, gender, diagnosis, operation type, comorbidity, and social deprivation, laparoscopic surgery was a strong determinant of reduced 30-day (odds ratio, 0.57; 95% confidence interval, 0.44-0.74; P < 0.001) and one-year (odds ratio, 0.53; 95% confidence interval, 0.42-0.67; P < 0.001) mortality. Similarly, multivariate analysis confirmed that laparoscopic surgery was independently associated with reduced hospital stay (P < 0.001). Patients who received rectal procedures for malignancy, however, were more likely to be readmitted if laparoscopy rather than by a traditional method was used (11.9% vs. 9.1%, P = 0.003). CONCLUSION: In the present study, patients selected for laparoscopic colorectal surgery were associated with reduced postoperative mortality when compared with those undergoing the conventional technique. This finding merits further investigation.
Faiz O, Smith J, Clark S, 2009, Unacceptable variation in abdominoperineal excision rates for rectal cancer, Gut, Vol: 58, ISSN: 1468-3288
Faiz O, Kennedy R, Warusavitarne J, et al., 2008, Laparoscopic and open elective colonic and rectal resection: A comparison of outcomes in English NHS trusts between 1996 and 2006, Annual Meeting of the American-Society-of-Colon-and-Rectal-Surgeons/Tripartite Meeting, Publisher: LIPPINCOTT WILLIAMS & WILKINS, Pages: 668-668, ISSN: 0012-3706
Warusavitarne J, Faiz O, El-Zanfaly M, et al., 2008, Surgery in complex rectal cancers is associated with good long term outcomes, Annual Meeting of the American-Society-of-Colon-and-Rectal-Surgeons, Publisher: SPRINGER, Pages: 766-766, ISSN: 0012-3706
Warusavitarne J, Faiz O, Cicoritti L, et al., 2008, Presacral tumors: A single institution experience, Annual Meeting of the American-Society-of-Colon-and-Rectal-Surgeons, Publisher: SPRINGER, Pages: 774-774, ISSN: 0012-3706
Mayer E, Faiz O, Athanasiou T, et al., 2008, Measuring and enhancing elective service performance in NHS operating theatres: an overview, Journal of the Royal Society of Medicine, Vol: 101, Pages: 273-277, ISSN: 0141-0768
Pimentel P, Rosel S, Roda D, et al., 2008, Locally advanced rectal cancer treated with preoperative chemoradiation:: Analysis of factors predicting recurrence and survival, Joint Annual Conference of the European-Society-of-Medical-Oncology/Japanese-Society-of-Medical-Oncology, Publisher: ELSEVIER, Pages: 142-142, ISSN: 0923-7534
Faiz O, Clark J, Brown T, et al., 2008, Traditional and laparoscopic appendectomy in adults: outcomes in English NHS hospitals between 1996 and 2006, Annals of surgery, Vol: 248, Pages: 800-806
OBJECTIVE: This study investigated length of stay, readmission rates, and postoperative mortality in adult patients undergoing traditional and laparoscopic appendectomy in England between April 1, 1996, and March 31, 2006. METHODS: All procedures coded to the "H01-Emergency Excision of Appendix" procedure code in the Hospital Episode Statistics database were included. Multivariate analyses were used to identify independent predictors of length of hospital stay, 30-day and 365-day mortality. RESULTS: A total of 259,735 procedures were assigned to the H01-Emergency excision of appendix OPCS-4 3-digit code procedure between 1996 and 2006. A laparoscopic technique was employed in 16,315 (6.3%). A greater proportion of deaths occurred in hospital within 30 days of "open" appendectomy surgery (0.25%) compared with procedures utilizing a laparoscopic technique (0.09%, P < 0.001). One-year mortality rates, measured over a 5-year period, were also higher after open surgery (0.64% vs. 0.29%, P < 0.001). Multiple logistic regressions demonstrated that an open operative technique, older age, male gender, and increasing comorbidity were strong independent determinants of early and 1-year postoperative mortality after emergency appendectomy. The duration of stay for patients undergoing open emergency appendectomy exceeded that for patients undergoing the laparoscopic technique (P < 0.001). Patients undergoing a laparoscopic technique were, however, more likely to be readmitted within 28 days of surgery (7.10% vs. 4.95%, P < 0.001). CONCLUSIONS: Laparoscopic appendectomy is safe and associated with lower postoperative mortality rates than open procedures. The cost implications are uncertain as this technique is associated with shorter hospital stay but higher subsequent readmission rates.
Faiz OD, Brown TJ, Colucci G, et al., 2008, Trends in colorectal day case surgery in NHS Trusts between 1998 and 2005, Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland, Vol: 10, Pages: 935-942, ISSN: 1463-1318
OBJECTIVE: Day case surgery is safe and offers potential benefits to both patients and healthcare providers. This study aimed to describe national changes in colorectal day case workload between 1998 and 2005. METHODS: Admission data relating to Office of Population Censuses and Surveys Classification of Surgical Operations and Procedures (4th revision) (OPCS-4) coloproctology operation codes were analysed using the Hospital Episode Statistics (HES) database. Day case rates (DCRs) were calculated as the proportion of elective cases performed on an ambulatory basis. RESULTS: In total, 3 119 058 colorectal admissions were recorded on the HES database between 1998 and 2005; 1 891 474 (61%) of these were for lower gastrointestinal endoscopies. Emergency cases accounted for 527 665 (17%), elective inpatient cases for 406 368 (13%) and elective day cases for 293 551 (9%) admissions. Throughout the study period the DCRs for five commonly performed elective colorectal procedures were: 0.70 for anal lesion excisions (OPCS-4 codes: H48.1, H48.2 and H48.3); 0.16 for haemorrhoidectomy (OPCS-4 code: H51.1); 0.63 for anal fissure procedures (OPCS-4 codes: H56.2 and H56.4); 0.39 for elective procedures for anal fistula (OPCS-4 codes: H55.1, H55.2, H55.3 and H55.4); 0.37 for elective pilonidal surgery (OPCS-4 codes: H59 and H60.2). Two emergency operations, drainage of perianal and pilonidal abscesses (OPCS-4 codes: H58.2 and H60.3 respectively), were identified as operations potentially amenable to day surgery. Over the seven study years, an annual average of 8559 (+/-SD 307) admissions were coded to drainage of a perianal abscess and 4676 (+/-SD 478) admissions to drainage of pilonidal abscess. The average annual bed usage associated with these procedures was 18 831 (+/-SD 718) and 7623 (+/-SD 436) bed days respectively. CONCLUSIONS: Colorectal day case surgery is currently under-exploited in the NHS. By lifting some of the barriers to day case surgery significant resource saving
Faiz O, Blackburn SC, Clark J, et al., 2008, Laparoscopic and conventional appendicectomy in children: outcomes in English hospitals between 1996 and 2006, Pediatric surgery international, Vol: 24, Pages: 1223-1227, ISSN: 0179-0358
BACKGROUND: Laparoscopic appendicectomy is increasingly used in children. This national retrospective study compared outcomes of paediatric open and laparoscopic appendicectomy. METHODS: Length of stay, readmission rates and mortality in children undergoing open and laparoscopic appendicectomy in English NHS Trusts between 1 April 1996 and 31 March 2006 were compared. Procedures coded as emergency excision of appendix (OPCS-4 H01) on the Hospital Episode Statistics (HES) database in patients less than 15 years of age were included. Multivariate analysis was used to identify independent predictors of length of hospital stay and mortality. RESULTS: Eighty-nine thousand, four-hundred and ninety-seven (89,497) appendicectomies were studied; of which, 2,689 (3%) were performed laparoscopically. The percentage of laparoscopic cases rose from 0.6 to 8.4% between 1996 and 2006 (Pearson's r = 0.954, P < 0.001). Length of stay (median 3, interquartile range 2 days, P = 0.068) and 28-day readmission rates were similar (6.3 vs. 7.2%, respectively; P = 0.072) between groups. No independent hospital stay advantage for laparoscopy was observed (P = 0.121). No difference in 30-day mortality (P = 0.986) or 365-day mortality (P = 0.598) was demonstrated. CONCLUSION: Hospital stay, readmission rates and mortality are similar following laparoscopic and open appendicectomy in children.
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