Publications
101 results found
Almoudaris, 2011, Imaging of Acute Appendicitis in Adults and Children, Imaging of Acute Appendicitis in Adults and Children, Editors: Keyzer, Gevenois, Keyzer, Gevenois, Keyzer, Gevenois, Publisher: Springer Verlag, Pages: 45-55, ISBN: 9783642178719
Treatment of Appendiceal Perforation Alex M. Almoudaris and Omar Faiz Abstract The treatment of appendiceal perforation is subject to considerable debate in ...
Almoudaris A, Faiz O, 2011, Imaging of Acute Appendicitis in Adults and Children, Imaging of Acute Appendicitis in Adults and Children, Editors: Keyzer, Gevenois, Publisher: Springer Verlag, Pages: 57-68, ISBN: 9783642178719
This comprehensive reference offers extensive background information, and considers each modality - radiography, ultrasound, CT, and MRI - separately in adults ...
Faiz O, Burns E, Nicholls J, 2011, Authors' reply: Volume analysis of outcome following restorative proctocolectomy (<i>Br J Surg</i> 2011; 98: 408-417), BRITISH JOURNAL OF SURGERY, Vol: 98, Pages: 1031-1032, ISSN: 0007-1323
Faiz O, Blackburn S, Moffat D, 2011, Anatomy at a Glance, Publisher: Wiley-Blackwell, ISBN: 9781444336092
Following the familiar, easy-to-use at a Glance format, and in full-colour, this new edition provides an accessible introduction and revision aid for medical, ...
Mamidanna R, Bottle A, Aylin P, et al., 2011, Open <i>versus</i> minimally invasive oesophagectomy for cancer: short term outcomes from an English population based study, International Surgical Congress of the Association-of-Surgeons-of-Great-Britain-and-Ireland, Publisher: WILEY-BLACKWELL, Pages: 5-5, ISSN: 0007-1323
Currie A, Burns E, Darzi A, et al., 2011, Can calman-trained consultants cut it in rectal cancer surgery?, International Surgical Congress of the Association-of-Surgeons-of-Great-Britain-and-Ireland, Publisher: WILEY-BLACKWELL, Pages: 130-130, ISSN: 0007-1323
Almoudaris AM, Gupta S, Bottle A, et al., 2011, POLYPECTOMY AT COLONOSCOPY AND SIGMOIDOSCOPY IN ENGLAND: A REVIEW OF NATIONAL DATA BETWEEN 1997 AND 2007, Annual Meeting on British-Society-of-Gasenterology, Publisher: B M J PUBLISHING GROUP, ISSN: 0017-5749
Almoudaris AM, Gupta S, Bottle A, et al., 2011, SURGERY FOR BENIGN COLORECTAL POLYPS IN ENGLAND - TRENDS AND OUTCOMES FROM 1997 TO 2007, Annual Meeting on British-Society-of-Gasenterology, Publisher: B M J PUBLISHING GROUP, ISSN: 0017-5749
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Gupta S, Miskovic D, Bhandari P, et al., 2011, THE 'SMSA' SCORING SYSTEM FOR DETERMINING THE COMPLEXITY OF A POLYP, Annual Meeting on British-Society-of-Gasenterology, Publisher: B M J PUBLISHING GROUP, Pages: A129-A129, ISSN: 0017-5749
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- Citations: 10
Mamidanna R, Stonell C, Faiz O, 2011, Complications and mortality in older surgical patients in Australia and New Zealand (the REASON study): a multicentre, prospective, observational study, ANAESTHESIA, Vol: 66, Pages: 132-133, ISSN: 0003-2409
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- Citations: 3
Faiz O, Haji A, Burns E, et al., 2011, Hospital stay amongst patients undergoing major elective colorectal surgery: predicting prolonged stay and readmissions in NHS hospitals, Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland, Vol: 13, Pages: 816-822, ISSN: 1463-1318
AIM: Reduced hospital stay confers clinical and economic benefits for patients and healthcare providers. This article examines the length of stay and consequent bed resource usage of patients undergoing elective excisional colorectal surgery in English NHS trusts. METHOD: All patients undergoing elective colorectal resections for malignancy between 1996 and 2006 in English NHS trusts were included from the Hospital Episode Statistics data set. Unifactorial and multifactorial analyses were performed to identify independent predictors of prolonged stay and 28-day readmission. RESULTS: Over the 10-year period, 186,013 patients underwent elective colorectal procedures in 181 NHS trusts. About 2.893 b million bed days were utilized for elective colorectal surgery. Admission stay was shorter following colonic surgery than following rectal surgery (median 11 vs 13 days, P < 0.001). A 2-day decrease in median stay was observed over the 10-year period for both colonic and rectal procedures. Readmissions within 28 days of discharge were higher following rectal excision than following colonic surgery (9.4 vs 7.6%, P < 0.001). Multiple logistic regression analyses revealed the following independent predictors of prolonged hospital stay: distal (vs proximal) bowel resection, benign pathology, open technique, increasing age, comorbidity, social deprivation and low provider volume status. Independent predictors of 28-day readmission included distal bowel resection, benign diagnosis, young age, social deprivation and high provider volume status. CONCLUSION: Patients of advanced age, with associated comorbidities, and those living in areas of social deprivation are at increased risk of prolonged stay. Targeted pre-emptive discharge planning and enhanced use of laparoscopic surgery could improve bed resource utilization.
Faiz O, Haji A, Bottle A, et al., 2011, Elective colonic surgery for cancer in the elderly: an investigation into postoperative mortality in English NHS hospitals between 1996 and 2007, Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland, Vol: 13, Pages: 779-785, ISSN: 1463-1318
BACKGROUND: This study was primarily aimed to quantify perioperative mortality risk in elderly patients undergoing elective colonic resectional surgery. In addition, the safety of minimally invasive colonic surgery in this patient group was evaluated. METHODS: All patients aged > 75 undergoing elective colonic resection for colorectal malignancy between 1996 and 2007 in English NHS hospitals were included from the Hospital Episode Statistics (HES) dataset. RESULTS: Between the study dates, 28,746 patients > 75 years underwent elective colonic resection. The national annual number of colonic excisions carried out amongst elderly patients increased from 2188 patients in 1996/7 to 3240 patients in 2006/7. Following adjustment for gender, comorbidity and surgical approach, advancing age was an independent predictor for 30-day mortality (OR 2.47 for patients aged 85-89 vs 75-79, P < 0.001). Use of laparoscopy was a significant predictor of reduced perioperative mortality (OR 0.56, P = 0.003) once adjusted for advancing age, gender and comorbidity. Comparison of 30-day and 1-year postoperative mortality following elective colonic resection in patients aged 90 revealed a large excess of patients dying outside of the immediate perioperative period (10.1% and 26.2% for proximal cancers, respectively; 12.9% and 36.1% for distal colonic resections, respectively). CONCLUSIONS: Advancing age is an independent risk factor for postoperative death in elderly patients undergoing elective colonic resection for cancer. The risk of death in the elderly is extremely high and surgical decision-making should incorporate the mortality risk that occurs outside the immediate perioperative period. In this national series, patients selected for a laparoscopic procedure were at lower risk of perioperative death than those undergoing the conventional approach.
Almoudaris AM, Clark S, Vincent C, et al., 2011, Establishing quality in colorectal surgery, Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland, Vol: 13, Pages: 961-973, ISSN: 1463-1318
AIM: The review aimed to offer a contemporary perspective of the quality of current colorectal surgery. METHOD: A literature search was undertaken to identify relevant indicators. Citations were included if they related to quality in colorectal surgery. The search terms used included the Medical Subject Heading terms and Boolean characters: 'colon' OR 'colorectal', OR 'rectal' OR 'rectum' AND 'Quality Indicators', OR 'Quality Assurance', OR 'Quality of healthcare', OR 'Reference Standards', OR 'Quality' plus a variable floating term. A two-person independent review was undertaken from resulting citations and their consequent reference lists. The search was limited to citations from 2000 to 2010 in humans and to the English language. RESULTS: Metrics identified as potential quality indicators in colorectal surgery are discussed according to the structure, process and outcome framework. CONCLUSION: A clear appreciation of the scope of individual metrics for quality appraisal purposes is necessary if they are to be used meaningfully for performance benchmarking.
Almoudaris AM, Burns EM, Bottle A, et al., 2011, A colorectal perspective on voluntary submission of outcome data to clinical registries, The British journal of surgery, Vol: 98, Pages: 132-139, ISSN: 1365-2168
BACKGROUND: The aim of the study was to identify outcome differences amongst patients undergoing resection of colorectal cancer at English National Health Service trusts using Hospital Episode Statistics (HES). A comparison was undertaken of trusts that submitted and those that did not submit, or submitted only poorly, voluntarily to a colorectal clinical registry, the National Bowel Cancer Audit Programme (NBOCAP). METHODS: The NBOCAP data set was used to classify trusts according to submitter status. HES data were used for outcome analysis. Data for major resections of colorectal cancer performed between 1 August 2007 and 31 July 2008 were obtained from HES. Trusts not submitting data to NBOCAP and those submitting less than 10 per cent of their total workload were termed 'non-submitters'. HES data for 30-day mortality, length of stay and readmission rates were compared according to submitter and non-submitter status in multifactorial analyses. RESULTS: A total of 17,722 patients were identified from HES for inclusion. Unadjusted 30-day in-hospital mortality rates were higher in non-submitting than in submitting trusts (5.2 versus 4.0 per cent; P = 0.005). Submitter status was independently associated with reduced 30-day mortality (odds ratio 0.76, 95 per cent confidence interval 0.61 to 0.96; P = 0.021) in regression analysis. CONCLUSION: A higher postoperative mortality rate following resection of colorectal cancer was found in trusts that do not voluntarily report data to NBOCAP. Implications regarding the voluntary nature of submission to such registries should be reviewed if they are to be used for outcome benchmarking.
Mamidanna R, Faiz O, 2011, Laparoscopic colectomy is safe and leads to a significantly shorter hospital stay for octogenarians, Surgical endoscopy, Vol: 25, Pages: 983-984, ISSN: 1432-2218
Burns EM, Bottle A, Aylin P, et al., 2011, Volume analysis of outcome following restorative proctocolectomy, The British journal of surgery, Vol: 98, Pages: 408-417, ISSN: 1365-2168
BACKGROUND: This observational study aimed to determine national provision and outcome following pouch surgery (restorative proctocolectomy, RPC) and to examine the effect of institutional and surgeon caseload on outcome. METHODS: All patients undergoing primary RPC between April 1996 and March 2008 in England were identified from the administrative database Hospital Episode Statistics. Institutions and surgeons were categorized according to the total RPC caseload performed over the study interval. RESULTS: Some 5771 primary elective pouch procedures were undertaken at 154 National Health Service hospital trusts. Median follow-up was 65 (interquartile range (i.q.r.) 28-106) months. The 30-day in-hospital mortality rate was 0.5 per cent and the 1-year overall mortality rate 1.5 per cent. Some 30.5 per cent of trusts performed fewer than two procedures per year, and 91.4 per cent of surgical teams (456 of 499) carried out 20 or fewer RPCs over 8 years. Median surgeon volume was 4 (i.q.r. 1-9) cases. Failure occurred in 6.4 per cent of cases. Low-volume surgeons operated on more patients at the extremes of age (P < 0.001) and a lower proportion with ulcerative colitis (P < 0.001). Older age, increasing co-morbidity, increasing social deprivation, and both lower provider and surgeon caseload were independent predictors of longer length of stay. Older patient age and low institutional volume status were independent predictors of failure. CONCLUSION: Many English institutions and surgeons carry out extremely low volumes of RPC surgery. Case selection differed significantly between high- and low-volume surgeons. Institutional volume and older age were positively associated with increased pouch failure.
Burns EM, Rigby E, Mamidanna R, et al., 2011, Systematic review of discharge coding accuracy, ISSN: 1741-3850
Introduction Routinely collected data sets are increasingly used for research, financial reimbursement and health service planning. High quality data are necessary for reliable analysis. This study aims to assess the published accuracy of routinely collected data sets in Great Britain. METHODS: Systematic searches of the EMBASE, PUBMED, OVID and Cochrane databases were performed from 1989 to present using defined search terms. Included studies were those that compared routinely collected data sets with case or operative note review and those that compared routinely collected data with clinical registries. RESULTS: Thirty-two studies were included. Twenty-five studies compared routinely collected data with case or operation notes. Seven studies compared routinely collected data with clinical registries. The overall median accuracy (routinely collected data sets versus case notes) was 83.2% (IQR: 67.3-92.1%). The median diagnostic accuracy was 80.3% (IQR: 63.3-94.1%) with a median procedure accuracy of 84.2% (IQR: 68.7-88.7%). There was considerable variation in accuracy rates between studies (50.5-97.8%). Since the 2002 introduction of Payment by Results, accuracy has improved in some respects, for example primary diagnoses accuracy has improved from 73.8% (IQR: 59.3-92.1%) to 96.0% (IQR: 89.3-96.3), P= 0.020. CONCLUSION: Accuracy rates are improving. Current levels of reported accuracy suggest that routinely collected data are sufficiently robust to support their use for research and managerial decision-making.
Burns EM, Bottle A, Aylin P, et al., 2011, Variation in reoperation after colorectal surgery in England as an indicator of surgical performance: retrospective analysis of Hospital Episode Statistics, Vol: 343, ISSN: 1468-5833
OBJECTIVE: To describe national reoperation rates after elective and emergency colorectal resection and to assess the feasibility of using reoperation as a quality indicator derived from routinely collected data in England. DESIGN: Retrospective observational study of Hospital Episode Statistics (HES) data. SETTING: HES dataset, an administrative dataset covering the entire English National Health Service. PARTICIPANTS: All patients undergoing a primary colorectal resection in England between 2000 and 2008. MAIN OUTCOME MEASURES: Reoperation after colorectal resection, defined as any reoperation for an intra-abdominal procedure or wound complication within 28 days of surgery on the index or subsequent admission to hospital. RESULTS: The national reoperation rate was 6.5% (15,986/246,469). A large degree of variation was identified among institutions and surgeons. Even among institutions and surgical teams with high caseloads, threefold and fivefold differences in reoperation rates were observed between the highest and lowest performing trusts and surgeons. Of the NHS trusts studied, 14.1% (22/156) had adjusted reoperation rates above the upper 99.8% control limit. Factors independently associated with higher risk of reoperation were diagnosis of inflammatory bowel disease (odds ratio 1.33 (95% CI 1.24 to 1.42), P<0.001), presence of multiple comorbidity (odds ratio 1.34 (1.29 to 1.39), P<0.001), social deprivation (1.14 (1.08 to 1.20) for most deprived, P<0.001), male sex (1.33 (1.29 to 1.38), P<0.001), rectal resection (1.63 (1.56 to 1.71), P<0.001), laparoscopic surgery (1.11 (1.03 to 1.20), P = 0.006), and emergency admission (1.21 (1.17 to 1.26), P<0.001). CONCLUSIONS: There is large variation in reoperation after colorectal surgery between hospitals and surgeons in England. If data accuracy can be assured, reoperation may allow performance to be checked against national standards from current routinely collected data, alongside other indicator
Learney RM, Ziprin P, Swift PA, et al., 2011, Acute Renal Failure in Association with Community-Acquired Clostridium difficile Infection and McKittrick-Wheelock Syndrome, Case reports in gastroenterology, Vol: 5, Pages: 438-444, ISSN: 1662-0631
We report the case of a 65-year-old Caucasian woman who experienced two separate episodes of acute renal failure within an 18-month period, both requiring emergency admission and complicated treatment. Each episode was precipitated by hypovolaemia from intestinal fluid losses, but from two rare and independent pathologies. Her first admission was attributed to community-acquired Clostridium difficile-associated diarrhoea (CDAD) and was treated in the intensive therapy unit. She returned 18 months later with volume depletion and electrolyte disturbances, but on this occasion a giant hypersecretory villous adenoma of the rectum (McKittrick-Wheelock syndrome) was diagnosed following initial abnormal findings on digital rectal examination by a junior physician. Unlike hospital-acquired C. difficile, community-acquired infection is not common, although increasing numbers are being reported. Whilst community-acquired CDAD can be severe, it rarely causes acute renal failure. This case report highlights the pathological mechanisms whereby C. difficile toxin and hypersecretory villous adenoma of the rectum can predispose to acute renal failure, as well as the values of thorough clinical examination in the emergency room, and early communication with intensivist colleagues in dire situations.
Almoudaris AM, Burns EM, Mamidanna R, et al., 2011, Value of failure to rescue as a marker of the standard of care following reoperation for complications after colorectal resection, The British journal of surgery, Vol: 98, Pages: 1775-1783, ISSN: 1365-2168
BACKGROUND: Complication management appears to be of vital importance to differences in survival following surgery between surgical units. Failure-to-rescue (FTR) rates have not yet distinguished surgical from general medical complications. The aim of this study was to assess whether variability exists in FTR rates after reoperation for serious surgical complications following colorectal cancer resections in England. METHODS: The Hospital Episode Statistics (HES) database was used to identify patients undergoing primary resection for colorectal cancer between 2000 and 2008 in English National Health Service (NHS) trusts. Units were ranked into quintiles according to overall risk-adjusted mortality. Highest and lowest mortality quintiles were compared with respect to reoperation rates and FTR-surgical (FTR-S) rates. FTR-S was defined as the proportion of patients with an unplanned reoperation who died within the same admission. RESULTS: Some 144 542 patients undergoing resection for colorectal cancer in 150 English NHS trusts were included. On ranking according to risk-adjusted mortality, rates varied significantly between lowest and highest mortality quintiles (5.4 and 9.3 per cent respectively; P = 0.029). Lowest and highest mortality quintiles had equivalent adjusted reoperation rates (both 4.8 per cent; P = 0.211). FTR-S rates were significantly higher at units within the worst mortality quintile (16.8 versus 11.1 per cent; P = 0.002). CONCLUSION: FTR-S rates differed significantly between English colorectal units, highlighting variability in ability to prevent death in this high-risk group. This variability may represent differences in serious surgical complication management. FTR-S represents a readily collectable marker of surgical complication management that is likely to be applicable to other surgical specialties. Copyright (c) 2011 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.
Faiz O, Nicholls J, Darzi A, 2011, Authors' reply to HESteria or hype?, Vol: 343, ISSN: 1468-5833
Mamidanna R, Faiz O, 2011, Laparoscopic colorectal surgery in elderly patients: a case-control study of 15 years of experience, American journal of surgery, ISSN: 1879-1883
Mamidanna R, Almoudaris A, Faiz O, 2011, Is 30 day mortality an appropriate measure of risk in elderly patients undergoing elective colorectal resection?, Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland, ISSN: 1463-1318
Aim: The study aimed to define the mortality in the elderly following elective colorectal resection and to identify the most meaningful postoperative period to report mortality rates in this group of patients. Method: A systematic review was undertaken to identify studies that reported on mortality in the elderly following elective colorectal resection. MEDLINE, EMBASE and PUBMED searches were carried out by two independent reviewers and results were collated. Two reviewers conducted literature searches independently and the third reviewer acted as an arbiter in case of discordance. Results: 236 studies published in the year 2000 or later were identified in the search,. Those that included emergency surgery, patients operated prior to 1995 or did not comment on mortality in an elderly age group were excluded. Seventeen studies were finally included in the review. 30-day or post-operative mortality rates varied from 0% to 13.3%. Short term mortality was low in elderly patients selected for minimal access surgery. National population and registry observational audits reported higher short term mortality rates than most small case series or cohort studies. One national audit demonstrated that a significant mortality risk persists up to one year after surgery. Conclusion: Historical case series suggest that 30-day mortality following colorectal resection in the elderly is low. The reliability of 30-day mortality measures to reflect surgical success in this cohort is, however, questionable as a significant proportion of patients die in the months that follow surgery.
Garcia-Granero E, Faiz O, Flor-Lorente B, et al., 2011, Prognostic implications of circumferential location of distal rectal cancer, Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland, Vol: 13, Pages: 650-657, ISSN: 1463-1318
AIM: This study evaluated the prognostic importance of circumferential tumour position of mid and low rectal cancers. METHOD: All uT2, uT3 and uT4 tumours of the middle and lower rectum that underwent total mesorectal excision (TME) with curative intent between 1996 and 2006 were included. The predominant circumferential tumour position (anterior, posterior or circumferential) was defined on preoperative endorectal ultrasound examination (ERUS). The relationships between tumour position and other characteristics and recurrence were explored. RESULTS: Two hundred and five patients with distal rectal cancer were operated on for a uT2-T4 tumour. Median follow up was 49 months. The location of the tumour was predominantly anterior, posterior or circumferential in 128, 49 and 27 patients, respectively. Anterior tumours were more likely to receive neoadjuvant therapy (P = 0.016) and perioperative blood transfusion (P = 0.012). No significant differences were observed between circumferential position and pT or pN stage, circumferential resection margin involvement or mesorectal excision quality. Sixty-three (30.7%) patients developed recurrence, which was local only in 16 (7.8%). Although tumours involving 360 degrees of the rectal wall had a higher risk of local recurrence (P = 0.048), those with a predominant anterior or posterior position were not related to a higher risk of local or overall recurrence. CONCLUSION: Anterior rectal tumours do not differ in pathological characteristics from posterior tumours, and their prognosis is no worse when circumferential resection is complete.
Garces M, Garcia-Granero E, Faiz O, et al., 2011, Ultralow anterior resection for prolapsed giant solitary rectal polyp of Peutz-Jeghers type, The American surgeon, Vol: 77, Pages: 501-502, ISSN: 1555-9823
Faiz O, 2011, Response to Colorectal Cancer in Nonagenarians, Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland, ISSN: 1463-1318
Mamidanna R, Burns EM, Bottle A, et al., 2011, Reduced Risk of Medical Morbidity and Mortality in Patients Selected for Laparoscopic Colorectal Resection in England: A Population-Based Study, ISSN: 1538-3644
OBJECTIVES: To quantify the occurrence of significant medical complications following elective colorectal resection and investigate potential differences in medical morbidity following open and minimal access colorectal surgery. DESIGN: Retrospective analysis of Hospital Episode Statistics, which is a prospectively maintained national database. SETTING: All patients undergoing colorectal resection in National Health Service trusts in England. PATIENTS: Adult patients undergoing elective or planned surgery between April 2001 and March 2008. INTERVENTION: Colorectal resection for benign and malignant diagnoses. MAIN OUTCOME MEASURES: Mortality and morbidity at 30 days and 1 year following elective colorectal resection. RESULTS: One hundred thirty-eight thousand seven hundred thirty-five elective colorectal resections were identified between the study dates. Thirty-day in-hospital mortality was 3.4% and 1.7% following conventional and laparoscopic surgery, respectively (P < .001). Overall, the 30-day postoperative medical morbidity rate was 14.6%. Use of the minimal access approach demonstrated a significant reduction in total morbidity risk at 30 days (odds ratio, 0.79; P < .001) and 365 days (odds ratio, 0.81; P < .001) following case-mix adjustment. Multiple regression analyses demonstrated that cardiorespiratory complications and venous thromboembolism occurred less frequently during the index admission and up to 1 year following minimal access surgery when compared with the conventional approach (P < .049). CONCLUSIONS: In this population-based study, patients selected for laparoscopic colorectal resection were associated with lower risk of mortality as well as reduced cardiorespiratory and venous thromboembolic risk than those undergoing open surgery.
Burns EM, Naseem H, Bottle A, et al., 2010, Introduction of laparoscopic bariatric surgery in England: observational population cohort study, BMJ-BRITISH MEDICAL JOURNAL, Vol: 341, ISSN: 1756-1833
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Lazzarino AI, Nagpal K, Bottle A, et al., 2010, Open Versus Minimally Invasive Esophagectomy <i>Trends of Utilization and Associated Outcomes in England</i>, ANNALS OF SURGERY, Vol: 252, Pages: 292-298, ISSN: 0003-4932
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Mamidanna R, Almoudaris AM, Faiz O, 2010, Variability in length of stay after colorectal surgery: assessment of 182 hospitals in the national surgical quality improvement program, Annals of surgery, Vol: 252, Pages: 891-892, ISSN: 1528-1140
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