Imperial College London

DrSarahOnida

Faculty of MedicineDepartment of Surgery & Cancer

Honorary Clinical Lecturer
 
 
 
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Contact

 

+44 (0)20 3311 7317s.onida Website

 
 
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Location

 

4N 12North WingCharing Cross Campus

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Summary

 

Publications

Publication Type
Year
to

107 results found

Jasionowska S, Turner B, Machin M, Onida S, Gwozdz A, Shalhoub J, Davies Aet al., 2022, Systematic review of exercise therapy in the management of post-thrombotic syndrome, Phlebology, ISSN: 0268-3555

Journal article

Turner B, Jasionowska S, Machin M, Javed A, Gwozdz A, Shalhoub J, Onida S, Davies Aet al., 2022, Systematic review and meta-analysis of exercise therapy for venous leg ulcer healing and recurrence, Journal of vascular surgery. Venous and lymphatic disorders, ISSN: 2213-3348

Journal article

Shaydakov ME, Ting W, Sadek M, Aziz F, Diaz JA, Comerota AJ, Lurie F, Blebea J, Eklof BG, Lugli M, De Maeseneer MGR, Kakkos SK, Nicolaides A, Heim D, Welch HJet al., 2022, Extended anticoagulation for venous thromboembolism: A survey of the American Venous Forum and the European Venous Forum, JOURNAL OF VASCULAR SURGERY-VENOUS AND LYMPHATIC DISORDERS, Vol: 10, Pages: 1012-+, ISSN: 2213-333X

Journal article

Thygesen JH, Tomlinson C, Hollings S, Mizani MA, Handy A, Akbari A, Banerjee A, Cooper J, Lai AG, Li K, Mateen BA, Sattar N, Sofat R, Torralbo A, Wu H, Wood A, Sterne JAC, Pagel C, Whiteley WN, Sudlow C, Hemingway H, Denaxas Set al., 2022, COVID-19 trajectories among 57 million adults in England: a cohort study using electronic health records, LANCET DIGITAL HEALTH, Vol: 4, Pages: E542-E557

Journal article

Ambler GK, Hitchman L, Benson RA, Birmpili P, Blair RHJ, Bosanquet DC, Dattani N, Dovell G, Gwilym BL, Hurndall K, Machin M, Nandhra S, Onida S, Shalhoub J, Singh AA, Saratzis Aet al., 2022, Comment on: Collaborative research: population-based data and validation are necessary, BRITISH JOURNAL OF SURGERY, Vol: 109, Pages: E111-E112, ISSN: 0007-1323

Journal article

Ambler G, Hitchman L, Benson R, Birmpili P, Blair R, Bosanquet D, Dattani N, Dovell G, Gwilym B, Hurndall K, Machin M, Nandhra S, Onida S, Shalhoub J, Singh A, Saratzis Aet al., 2022, Surgical collaboratives – here to stay, British Journal of Surgery, ISSN: 0007-1323

Journal article

Machin M, Younan H-C, Guéroult A, Shalhoub J, Onida S, Davies Aet 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

Journal article

Tan K, Salim S, Machin M, Geroult A, Onida S, Lane T, Davies Aet al., 2022, Abdominal aortic aneurysm clinical practice guidelines: a methodological assessment using the AGREE II instrument, BMJ Open, Vol: 12, Pages: 1-9, ISSN: 2044-6055

Objectives: Abdominal aortic aneurysm (AAA) clinical practice guidelines (CPGs) provide evidence-based information on patient management; however, methodological differences exist in the development of CPGs. This study examines the methodological quality of AAA CPGs using a validated assessment tool. Design: Medline, EMBASE and online CPG databases were searched from 1946 to 31st October 2021. Full-text, English language, evidence-based AAA CPGs were included. Consensus-based CPGs, summaries of CPGs or CPGs which were only available upon purchase were excluded. Five reviewers assessed their quality using the Appraisal of Guidelines for Research and Evaluation II instrument. An overall guideline assessment scaled score of ≥80% was considered as the threshold to recommend CPG use in clinical practice.Results: Seven CPGs were identified. Scores showed good inter-reviewer reliability (ICC 0.943, 95% CI 0.915-0.964). On average, CPGs performed adequately with mean scaled scores of over 50% in all domains. However, between CPGs, significant methodological heterogeneity was observed in all domains. Four CPGs scored ≥80% (European Society of Cardiology, the Society of Vascular Surgery, the European Society of Vascular Surgery, and the National Institute of Health and Care Excellence), supporting their use in clinical practice.Conclusions: Four CPGs were considered of adequate methodological quality to recommend their use in clinical practice; nonetheless, these still showed areas for improvement, potentially through performing economic analysis and trial application of recommendations. A structured approach employing validated CPG creation tools should be used to improve rigour of AAA CPGs. Future work should also evaluate recommendation accuracy using validated appraisal tools.

Journal article

Sutanto SA, Tan M, Onida S, Davies AHet al., 2022, A systematic review on isolated coil embolization for pelvic venous reflux, Journal of vascular surgery. Venous and lymphatic disorders, Vol: 10, Pages: 224-232.e9, ISSN: 2213-3348

OBJECTIVE: Pelvic venous reflux (PVR) can present with symptoms such as chronic pelvic pain, dysmenorrhea, and dyspareunia, resulting in a decreased quality of life among those affected. Percutaneous coil embolization (CE) is a common intervention for PVR; however, the efficacy and safety of its use in isolation has yet to be reviewed. METHODS: The MEDLINE and EMBASE databases were systematically searched from 1990 to July 20, 2020, for studies reporting on adult patients undergoing isolated CE for PVR. Articles not in English, case reports, studies reporting on pediatric patients, and studies not performing isolated CE were excluded. Search, review, and data extraction were performed by two independent reviewers (S.S. and M.T.). Changes in pain before and after CE was evaluated through a pooled analysis of visual analogue scale scores in seven studies. RESULTS: A total of 970 patients (range, 3-218, 100% female) undergoing isolated ovarian vein or mixed veins embolization from 20 studies were included. Pooled analysis revealed mean improvements of 5.47 points (95% CI, 4.77-6.16) on the visual analogue scale. Common symptoms such as urinary urgency and dyspareunia reported significant improvements of 78-100% and 60-89.5% respectively. Complications were rare, with coil migration (n = 19) being the most common. Recurrence rates differed based on the varying symptoms and studies, with recurrence in pain 1-2 years after CE ranging from 5.9-25%. Two randomized controlled trials revealed improved clinical outcomes with CE as compared with vascular plugs and hysterectomy. CONCLUSIONS: The current data suggests that isolated CE is technically effective and can result in clinical improvement among patients with PVR. However, further trials are required to ascertain its long-term effects.

Journal article

Shaydakov ME, Ting W, Sadek M, Aziz F, Diaz JA, Raffetto JD, Marston WA, Lal BK, Welch HJet al., 2021, Review of the current evidence for topical treatment for venous leg ulcers, JOURNAL OF VASCULAR SURGERY-VENOUS AND LYMPHATIC DISORDERS, Vol: 10, Pages: 241-+, ISSN: 2213-333X

Journal article

Salim S, Machin M, Patterson BO, Onida S, Davies AHet al., 2021, Global Epidemiology of Chronic Venous Disease A Systematic Review With Pooled Prevalence Analysis, ANNALS OF SURGERY, Vol: 274, Pages: 971-976, ISSN: 0003-4932

Journal article

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

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

Geoghegan L, Super J, Machin M, Gimzewska M, Onida S, Hettiaratchy S, Davies AHet al., 2021, Are venous thromboembolism risk assessment tools reliable in the stratification of microvascular risk following lower extremity reconstruction?, JPRAS Open, Vol: 29, Pages: 45-54, ISSN: 2352-5878

IntroductionThe incidence of flap failure is significantly higher in the lower extremity compared to free tissue transfer in the head, neck and breast. The most common cause of flap failure is venous thrombosis. The aim of this study was to assess the reliability of venous thromboembolism (VTE) risk assessment tools in this high-risk cohort and to assess the ability of such tools to identify patients at risk of developing microvascular venous thrombosis and venous thromboembolism following lower extremity free flap reconstruction.MethodsA single centre retrospective cohort study was conducted between August 2012-August 2019. Adult patients who had undergone free tissue transfer following open lower extremity fractures were eligible for inclusion. All patients were retrospectively risk assessed using the Department of Health (DoH), Modified Caprini and Padua VTE risk assessment tools.ResultsFifty-eight patients were included; all were at high risk of DVT according to the DoH (mean score ± SD, 3.7 ± 0.93), Caprini (10.2 ± 1.64) and Padua (5.4 ± 0.86) risk assessment tools. All patients received appropriate thromboprophylaxis; the incidence of symptomatic hospital acquired VTE was 3.5%. Micro-anastomotic venous thrombosis occurred in 4 patients resulting in one amputation. Partial flap necrosis occurred in 7 patients. There were no significant differences in scaled Caprini (median score, 10 vs 9, z = 1.289, p = 0.09), DoH (3 vs 3, z = 0.344, p = 0.36), and Padua (5 vs 5.5, z= -0.944, p = 0.17) scores between those with and without microvascular venous thrombosis.ConclusionThis data suggests that current VTE risk assessment tools do not predict risk of microvascular venous thrombosis following lower extremity reconstruction. Further prospective studies are required to optimise risk prediction models and thromboprophylaxis use in this cohort.

Journal article

Gwilym B, Maheswaran R, Edwards A, Thomas-Jones E, Michaels J, Bosanquet D, on behalf of the Groin wound Infection after Vascular Exposure GIVE Study Group, Shalhoub Jet al., 2021, Income deprivation and groin wound surgical site infection: cross-sectional analysis from the Groin wound Infection after Vascular Exposure (GIVE) multicentre cohort study, Surgical Infections, ISSN: 1096-2964

Journal article

Geoghegan L, Onida S, Davies AH, 2021, The use of venous-specific preference based measures in health economic evaluation: Comparing apples and pears?, PHLEBOLOGY, Vol: 37, Pages: 84-85, ISSN: 0268-3555

Journal article

Cruddas L, Onida S, Davies AH, 2021, Venous aneurysms: When should we intervene?, PHLEBOLOGY, Vol: 37, Pages: 3-4, ISSN: 0268-3555

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

Guni A, Machin M, Onida S, Shalhoub J, Davies Aet al., 2021, Acute iliofemoral DVT – what evidence is required to justify catheter-directed thrombolysis?, Phlebology, Vol: 36, Pages: 339-341, ISSN: 0268-3555

Journal article

Bergner R, Onida S, Velineni R, Spagou K, Gohel MS, Bouschbacher M, Bohbot S, Shalhoub J, Holmes E, Davies AHet al., 2021, Metabolic profiling reveals changes in serum predictive of venous ulcer healing, Annals of Surgery, ISSN: 0003-4932

Objective: The aim of this study was to identify potential biomarkers predictive of healing or failure to heal in a population with venous leg ulceration.Summary Background Data: Venous leg ulceration presents important physical, psychological, social and financial burdens. Compression therapy is the main treatment, but it can be painful and time-consuming, with significant recurrence rates. The identification of a reliable biochemical signature with the ability to identify nonhealing ulcers has important translational applications for disease prognostication, personalized health care and the development of novel therapies.Methods: Twenty-eight patients were assessed at baseline and at 20 weeks. Untargeted metabolic profiling was performed on urine, serum, and ulcer fluid, using mass spectrometry and nuclear magnetic resonance spectroscopy.Results: A differential metabolic phenotype was identified in healing (n = 15) compared to nonhealing (n = 13) venous leg ulcer patients. Analysis of the assigned metabolites found ceramide and carnitine metabolism to be relevant pathways. In this pilot study, only serum biofluids could differentiate between healing and nonhealing patients. The ratio of carnitine to ceramide was able to differentiate between healing phenotypes with 100% sensitivity, 79% specificity, and 91% accuracy.Conclusions: This study reports a metabolic signature predictive of healing in venous leg ulceration and presents potential translational applications for disease prognostication and development of targeted therapies.

Journal article

Staniszewska A, Gimzewska M, Onida S, Lane T, Davies AHet al., 2021, Lower extremity arterial interventions in England, ANNALS OF THE ROYAL COLLEGE OF SURGEONS OF ENGLAND, Vol: 103, Pages: 360-366, ISSN: 0035-8843

Journal article

Ravikumar R, Lane TRA, Babber A, Onida S, Davies AHet al., 2021, A randomised controlled trial of neuromuscular stimulation in non-operative venous disease improves clinical and symptomatic status, Phlebology, Vol: 36, Pages: 290-302, ISSN: 0268-3555

BackgroundThis randomised controlled trial investigates the dosing effect of neuromuscular electrical stimulation (NMES) in patients with chronic venous disease (CVD).MethodsSeventy-six patients with CEAP C3-C5 were randomised to Group A (no NMES), B (30 minutes of NMES daily) or C (60 minutes of NMES daily). Primary outcome was percentage change in Femoral Vein Time Averaged Mean Velocity (TAMV) at 6 weeks. Clinical severity scores, disease-specific and generic quality of life (QoL) were assessed.ResultsSeventy-six patients were recruited - mean age 60.8 (SD14.4) and 47:29 male. Six patients lost to follow-up. Percentage change in TAMV (p<0.001) was significantly increased in Groups B and C. Aberdeen Varicose Veins Questionnaire Score (-6.9, p=0.029) and Venous Clinical Severity Score (-4, p-0.003) improved in Group C, and worsened in Group A (+1, p=0.025).ConclusionsDaily NMES usage increases flow parameters, with twice daily usage improving QoL and clinical severity at 6 weeks in CVD patients.

Journal article

Cruddas L, Onida S, Davies AH, 2021, What, if anything, should replace the Villalta score for post thrombotic syndrome?, PHLEBOLOGY, Vol: 36, Pages: 595-596, ISSN: 0268-3555

Journal article

Salim S, Tan M, Geoghegan L, Belramman A, Onida S, Davies AHet al., 2021, A systematic review assessing the quality of clinical practice guidelines in chronic venous disease, JOURNAL OF VASCULAR SURGERY-VENOUS AND LYMPHATIC DISORDERS, Vol: 9, Pages: 787-+, ISSN: 2213-333X

Journal article

Wood A, Denholm R, Hollings S, Cooper J, Ip S, Walker V, Denaxas S, Akbari A, Banerjee A, Whiteley W, Lai A, Sterne J, Sudlow Cet al., 2021, Linked electronic health records for research on a nationwide cohort of more than 54 million people in England: data resource, BMJ-BRITISH MEDICAL JOURNAL, Vol: 372, ISSN: 0959-535X

Journal article

Onida S, Heatley F, Peerbux S, bolton L, Lane T, Epstein D, Gohel M, Poskitt K, Cullum N, Norrie J, Lee R, Bradbury A, Dhillon K, Chandrasekar A, Lomas R, Davies Aet al., 2021, Study protocol for a multicentre, randomised controlled trial to compare the use of the decellularised dermis allograft in addition to standard care versus standard care alone for the treatment of venous leg ulceration: DAVE trial, BMJ Open, Vol: 11, ISSN: 2044-6055

Introduction Venous leg ulceration (VLU), the most common type of chronic ulcer, can be difficult to heal and is a major cause of morbidity and reduced quality of life. Although compression bandaging is the principal treatment, it is time-consuming and bandage application requires specific training. There is evidence that intervention on superficial venous incompetence can help ulcer healing and recurrence, but this is not accessible to all patients. Hence, new treatments are required to address these chronic wounds. One possible adjuvant treatment for VLU is human decellularised dermis (DCD), a type of skin graft derived from skin from deceased tissue donors. Although DCD has the potential to promote ulcer healing, there is a paucity of data for its use in patients with VLU.Methods and analysis This is a multicentre, parallel group, pragmatic randomised controlled trial. One hundred and ninety-six patients with VLU will be randomly assigned to receive either the DCD allograft in addition to standard care or standard care alone. The primary outcome is the proportion of participants with a healed index ulcer at 12 weeks post-randomisation in each treatment arm. Secondary outcomes include the time to index ulcer healing and the proportion of participants with a healed index ulcer at 12 months. Changes in quality of life scores and cost-effectiveness will also be assessed. All analyses will be carried out on an intention-to-treat (ITT) basis. A mixed-effects, logistic regression on the outcome of the proportion of those with the index ulcer healed at 12 weeks will be performed. Secondary outcomes will be assessed using various statistical models appropriate to the distribution and nature of these outcomes.Ethics and dissemination Ethical approval was granted by the Bloomsbury Research Ethics Committee (19/LO/1271). Findings will be published in a peer-reviewed journal and presented at national and international conferences.

Journal article

Groin wound Infection after Vascular Exposure Study Group, Shalhoub J, 2021, Groin wound infection after vascular exposure (GIVE) multicentre cohort study, International Wound Journal, Vol: 18, Pages: 164-175, ISSN: 1742-4801

Background: Surgical site infections (SSIs) of groin wounds are a common and potentially preventable cause of morbidity, mortality and healthcare costs in vascular surgery. Our aim was to define the contemporaneous rate of groin SSIs, determine clinical sequelae, and identify risk factors for SSI.Method:An international multicentre prospective observational cohort study of consecutive patients undergoing groin incision for femoral vessel access in vascular surgery was undertaken over 3 months, follow up was 90 days. The primary outcome was incidence of groin wound SSI.Results:1337 groin incisions (1039 patients) from 37 centres were included. 115 groin incisions (8.6%) developed SSI, of which 62 (4.6%) were superficial. Patients who developed an SSI had a significantly longer length of hospital stay (6 vs 5 days, p=0.005), a significantly higher rate of post-operative acute kidney injury (19.6% vs 11.7%, p=0.018), with no significant difference in 90-day mortality. Female sex, Body Mass Index≥30kg/m2, ischaemic heart disease, aqueous betadine skin preparation, bypass/patch use (vein, xenograft or prosthetic) and increased operative time were independent predictors of SSI. Conclusion:Groin infections which are clinically apparent to the treating vascular unit are frequent and their development carries significant clinical sequelae. Risk factors include modifiable and non-modifiable variables.

Journal article

Salim S, Heatley F, Bolton L, Khatri A, Onida S, Davies AHet al., 2021, The management of venous leg ulceration post the EVRA (early venous reflux ablation) ulcer trial: Management of venous ulceration post EVRA, Phlebology, Vol: 36, Pages: 203-208, ISSN: 0268-3555

ObjectivesThis survey study evaluates current management strategies for venous ulceration and the impacts of the EVRA trial results.MethodsAn online survey was disseminated to approximately 15000 clinicians, through 12 vascular societies in 2018. Survey themes included: referral times, treatment times and strategies, knowledge of the EVRA trial and service barriers to managing venous ulceration. Data analysis was performed using Microsoft Excel and SPSS.Results664 responses were received from 78 countries. Respondents were predominantly European (55%) and North American (23%) vascular surgeons (74%). Responses varied between different countries. The median vascular clinic referral time was 6 weeks and time to be seen in clinic was 2 weeks. This was significantly higher in the UK (p ≤ 0.02). 77% of respondents performed surgical/endovenous interventions prior to ulcer healing, the median time to intervention was 4 weeks. 31% of participants changed their practice following EVRA. Frequently encountered barriers to implementing change were a lack of operating space/time (18%).ConclusionVenous ulcers are not managed as quickly as they should be. An evaluation of local resource requirements should be performed to improve service provision for venous ulceration. When interpreting the results of this survey consideration should be given to the response rate.

Journal article

Gwilym B, Dovell G, Dattani N, Ambler G, Shalhoub J, Forsythe R, Benson R, Nandhra S, Preece R, Onida S, Hitchman L, Coughlin P, Saratzis A, Bosanquet Det al., 2021, Systematic review and meta-analysis of wound adjuncts for the prevention of groin wound surgical site infection in arterial surgery, European Journal of Vascular and Endovascular Surgery, Vol: 61, Pages: 636-646, ISSN: 1078-5884

Review methodsThis review was undertaken according to established international reporting guidelines and was registered prospectively with the International prospective register of systematic reviews (CRD42020185170). The MEDLINE, EMBASE, and CENTRAL databases were searched using pre-defined search terms without date restriction. Randomised controlled trials (RCTs) and observational studies recruiting patients with non-infected groin incisions for arterial exposure were included; SSI rates and other outcomes were captured. Interventions reported in two or more studies were subjected to meta-analysis.ResultsThe search identified 1 532 articles. Seventeen RCTs and seven observational studies, reporting on 3 747 patients undergoing 4 130 groin incisions were included. A total of seven interventions and nine outcomes were reported upon. Prophylactic closed incision negative pressure wound therapy (ciNPWT) reduced groin SSIs compared with standard dressings (odds ratio [OR] 0.34, 95% CI 0.23 – 0.51; p < .001, GRADE strength of evidence: moderate). Local antibiotics did not reduce groin SSIs (OR 0.60 95% CI 0.30 – 1.21 p = .15, GRADE strength: low). Subcuticular sutures (vs. transdermal sutures or clips) reduced groin SSI rates (OR 0.33, 95% CI 0.17 – 0.65, p = .001, GRADE strength: low). Wound drains, platelet rich plasma, fibrin glue, and silver alginate dressings did not show any significant effect on SSI rates.ConclusionThere is evidence that ciNPWT and subcuticular sutures reduce groin SSI in patients undergoing arterial vascular interventions involving a groin incision. Local antibiotics did not reduce groin wound SSI, although the strength of this evidence is lower. No other interventions demonstrated a significant effect.

Journal article

Benson R, Nandhra S, Shalhoub J, 2021, Outcomes of vascular and endovascular interventions performed during the COronaVIrus Disease 2019 (COVID-19) pandemic: The Vascular and Endovascular Research Network (VERN) COvid-19 Vascular sERvice (COVER) Tier 2 study, Annals of Surgery, Vol: 273, Pages: 630-635, ISSN: 0003-4932

Objective: The aim of the COVER Study is to identify global outcomes and decision making for vascular procedures during the pandemic.Background data: During its initial peak, there were many reports of delays to vital surgery and the release of several guidelines advising later thresholds for vascular surgical intervention for key conditions.Methods: An international multi-centre observational study of outcomes following open and endovascular interventions.Results: In an analysis of 1,103 vascular intervention (57 centres in 19 countries), 71.6% were elective or scheduled procedures. Mean age was 67 ± 14 years (75.6% male). Suspected or confirmed COVID-19 infection was documented in 4.0%. Overall, in-hospital mortality was 11.0%. (aortic interventions mortality 15.2% [23/151], amputations 12.1% [28/232], carotid interventions 10.7% [11/103], lower limb revascularisations 9.8% [51/521]). Chronic obstructive pulmonary disease (Odds ratio [OR] 2.02, 95% CI 1.30-3.15) and active lower respiratory tract infection due to any cause (OR 24.94, 95% CI 12.57-241.70) ware associated with mortality, whereas elective or scheduled cases were lower risk (OR 0.4, 95% CI 0.22-0.73 and 0.60, 95% CI 0.45-0.98 respectively. After adjustment, antiplatelet (Odds Ratio [OR] 0.503, 95% Confidence Interval [CI]:0.273 - 0.928) and oral anticoagulation (OR 0.411, 95% CI: 0.205 - 0.824) were linked to reduced risk of in-hospital mortality.Conclusions: Mortality following vascular interventions during this period was unexpectedly high. Suspected or confirmed COVID-19 cases were uncommon. Therefore an alternative cause e.g. recommendations for delayed surgery, should be considered. The vascular community must anticipate longer term implications for survival.Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.

Journal article

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