Publications
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Williams GJ, Nicolaou M, Athanasiou T, et al., 2016, Suture needle handling in the operating theatre; what is the safest method? A survey of surgical nursing opinion, INJURY PREVENTION, Vol: 22, Pages: 135-139, ISSN: 1353-8047
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- Citations: 2
Askari A, Currie A, Nachiappan S, et al., 2016, The Risk of Developing Cancer in Patients With Inflammatory Bowel Disease (IBD): Does Infliximab Contribute to Risk?, 57th Annual Meeting and Residents Fellow Conference of the Society-for-Surgery-of-the-Alimentary-Tract (SSAT) / 52nd Annual Meeting on Digestive Disease Week (DDW) / Meeting of the American-Gastroenterological-Association (AGA), Publisher: W B SAUNDERS CO-ELSEVIER INC, Pages: S574-S575, ISSN: 0016-5085
Askari A, Currie A, Nachiappan S, et al., 2016, Wide Variation in Resection Rates and Survival in Elderly Colorectal Cancer Patients in England, 57th Annual Meeting and Residents Fellow Conference of the Society-for-Surgery-of-the-Alimentary-Tract (SSAT) / 52nd Annual Meeting on Digestive Disease Week (DDW) / Meeting of the American-Gastroenterological-Association (AGA), Publisher: W B SAUNDERS CO-ELSEVIER INC, Pages: S650-S650, ISSN: 0016-5085
Malietzis G, Currie AC, Johns N, et al., 2016, Skeletal muscle changes after elective colorectal cancer resection: a longitudinal study, Annals of Surgical Oncology, Vol: 23, Pages: 2539-2547, ISSN: 1534-4681
BackgroundMuscle depletion is a poor prognostic indicator in colorectal cancer (CRC) patients, but there were no data assessing comparative temporal body composition changes following elective CRC surgery. We examined patient skeletal muscle index trajectories over time after surgery and determined factors that may contribute to those alterations.MethodsPatients diagnosed with CRC undergoing elective surgical resection between 2006 and 2013 were included in this study. Image analysis of serial computed tomography (CT) scans was used to calculate lumbar skeletal muscle index (LSMI). A multilevel mixed-effect linear regression model was applied using STATA (version 12.0) using the xtmixed command to fit growth curve models (GCM) for LSMI and time.ResultsIn 856 patients, a total of 2136 CT images were analyzed; 856 (38.2 %) were preoperative. A quadratic GCM with random intercept and random slope for patients’ LSMI was identified that demonstrated laparoscopy produces a positive change on the LSMI curve [estimate = 0.17 cm2/m2, standard error (SE) 0.06 cm2/m2; p = 0.03], whereas Union for International Cancer Control (UICC) stage III + IV disease contributed to a negative curve change (estimate = −0.19 cm2/m2, SE 0.09 cm2/m2; p = 0.03). Older age (p < 0.01), female gender (p < 0.01), higher American Society of Anesthesiologists (ASA) score (p < 0.01), and altered systemic inflammatory response [SIR] (p = 0.03) were factors significantly associated with lower values of LSMI over time.ConclusionIn patients undergoing CRC surgery, laparoscopy and the absence of a significantly elevated SIR favored preservation and restoration of skeletal muscle, postoperatively. These emerging data may permit the development of new treatment protocols whereby monitoring and modification of body composition has therapeutic potential.It is becoming increasingly clear that a variety of body composition changes occur in cancer patients, and that muscle depletion is a comm
Barr JG, Sepehripour AH, Jarral OA, et al., 2016, A review of the surgical management of right-sided aortic arch aneurysms, Interactive Cardiovascular and Thoracic Surgery, Vol: 23, Pages: 156-162, ISSN: 1569-9293
Aneurysms and dissections of the right-sided aortic arch are rare and published data are limited to a few case reports and small series. The optimal treatment strategy of this entity and the challenges associated with their management are not yet fully investigated and conclusive. We performed a systematic review of the literature to identify all patients who underwent surgical or endovascular intervention for right aortic arch aneurysms or dissections. The search was limited to the articles published only in English. We focused on presentation and critically assessed different management strategies and outcomes. We identified 74 studies that reported 99 patients undergoing surgical or endovascular intervention for a right aortic arch aneurysm or dissection. The median age was 61 years. The commonest presenting symptoms were chest or back pain and dysphagia. Eighty-eight patients had an aberrant left subclavian artery with only 11 patients having the mirror image variant of a right aortic arch. The commonest pathology was aneurysm arising from a Kommerell's diverticulum occurring in over 50% of the patients. Twenty-eight patients had dissections, 19 of these were Type B and 9 were Type A. Eighty-one patients had elective operations while 18 had emergency procedures. Sixty-seven patients underwent surgical treatment, 20 patients had hybrid surgical and endovascular procedures and 12 had totally endovascular procedure. There were 5 deaths, 4 of which were in patients undergoing emergency surgery and none in the endovascular repair group. Aneurysms and dissections of a right-sided aortic arch are rare. Advances in endovascular treatment and hybrid surgical and endovascular management are making this rare pathology amenable to these approaches and may confer improved outcomes compared with conventional extensive repair techniques.
Athanasiou T, Patel V, Garas G, et al., 2016, Mentoring perception and academic performance: an Academic Health Science Centre survey, Postgraduate Medical Journal, Vol: 92, Pages: 597-602, ISSN: 1469-0756
Purpose To determine the association between professors' self-perception of mentoring skills and their academic performance.Design Two hundred and fifteen professors from Imperial College London, the first Academic Health Science Centre (AHSC) in the UK, were surveyed. The instrument adopted was the Mentorship Skills Self-Assessment Survey. Statement scores were aggregated to provide a score for each shared core, mentor-specific and mentee-specific skill. Univariate and multivariate regression analyses were used to evaluate their relationship with quantitative measures of academic performance (publications, citations and h-index).Results There were 104 professors that responded (response rate 48%). There were no statistically significant negative correlations between any mentoring statement and any performance measure. In contrast, several mentoring survey items were positively correlated with academic performance. The total survey score for frequency of application of mentoring skills had a statistically significant positive association with number of publications (B=0.012, SE=0.004, p=0.006), as did the frequency of acquiring mentors with number of citations (B=1.572, SE=0.702, p=0.030). Building trust and managing risks had a statistically significant positive association with h-index (B=0.941, SE=0.460, p=0.047 and B=0.613, SE=0.287, p=0.038, respectively).Conclusions This study supports the view that mentoring is associated with high academic performance. Importantly, it suggests that frequent use of mentoring skills and quality of mentoring have positive effects on academic performance. Formal mentoring programmes should be considered a fundamental part of all AHSCs’ configuration.
Porte F, Uppara M, Malietzis G, et al., 2016, CT colonography for surveillance of patients with colorectal cancer: Systematic review and meta-analysis of diagnostic efficacy, European Radiology, Vol: 27, Pages: 51-60, ISSN: 0938-7994
Purpose: To review primary research evidence investigating performance of CT colonography for colorectal cancer surveillance. The financial impact of using CT colonography for surveillance was also estimated.Methods: We identified primary studies of CT colonography for surveillance of colorectal cancer patients. A summary ROC curve was constructed. Inter-study heterogeneity was explored using the I2 value. Financial impact was estimated for a theoretical cohort of patients, based on Cancer Research UK statistics.Results: Seven studies provided data on 880 patients. Five of seven studies (765 patients) were included for qualitative analysis. Sensitivity of CT colonography for detection of anastomotic recurrence was 95 % (95 % CI 62 − 100), specificity 100 % (95 % CI 75 − 100) and sensitivity for metachronous cancers was 100 %. No statistical heterogeneity was detected (I2 = 0 %). We estimated that CT colonography as a 'single test' alternative to colonoscopy and standard CT for surveillance would potentially save €20,785,232 (£14,803,404) for an annual cohort of UK patients.Conclusion: CT colonography compares favourably to colonoscopy for detection of anastomotic recurrence and metachronous colorectal cancer, and appears financially beneficial. These findings should be considered alongside limitations of small patient numbers and high clinical heterogeneity between studies.Key Points: • CT colonography compares favourably to colonoscopy/standard CT for colorectal cancer surveillance.• CT colonography offers single-test luminal, serosal and extra-colonic assessment.• CT colonography is a potentially cost-saving alternative to standard surveillance protocols.
Malietzis G, Currie AC, Athanasiou T, et al., 2016, Influence of body composition profile on outcomes following colorectal cancer surgery, British Journal of Surgery, Vol: 103, Pages: 572-580, ISSN: 1365-2168
BackgroundMuscle depletion is characterized by reduced muscle mass (myopenia), and increased infiltration by intermuscular and intramuscular fat (myosteatosis). This study examined the role of particular body composition profiles as prognostic markers for patients with colorectal cancer undergoing curative resection.MethodsPatients with colorectal cancer undergoing elective surgical resection between 2006 and 2011 were included. Lumbar skeletal muscle index (LSMI), visceral adipose tissue (VAT) surface area and mean muscle attenuation (MA) were calculated by analysis of CT images. Reduced LSMI (myopenia), increased VAT (visceral obesity) and low MA (myosteatosis) were identified using predefined sex-specific skeletal muscle index values. Univariable and multivariable Cox regression models were used to determine the role of different body composition profiles on outcomes.ResultsSome 805 patients were identified, with a median follow-up of 47 (i.q.r. 24·9–65·6) months. Multivariable analysis identified myopenia as an independent prognostic factor for disease-free survival (hazard ratio (HR) 1·53, 95 per cent c.i. 1·06 to 2·39; P = 0·041) and overall survival (HR 1·70, 1·25 to 2·31; P < 0·001). The presence of myosteatosis was associated with prolonged primary hospital stay (P = 0·034), and myopenic obesity was related to higher 30-day morbidity (P = 0·019) and mortality (P < 0·001) rates.ConclusionMyopenia may have an independent prognostic effect on cancer survival for patients with colorectal cancer. Muscle depletion may represent a modifiable risk factor in patients with colorectal cancer and needs to be targeted as a relevant endpoint of health recommendations.
Moscarelli M, Cerillo A, Athanasiou T, et al., 2016, Minimally invasive mitral valve surgery in high-risk patients: operating outside the boxplot., Interactive Cardiovascular and Thoracic Surgery, Vol: 22, Pages: 756-761, ISSN: 1569-9293
OBJECTIVES: (i) To establish who is at high risk for mitral surgery. (ii) To assess the performance of minimally invasive mitral valve surgery in high-risk patients by presenting early and late outcomes and compare these with those of the non-high-risk population. METHODS: We reviewed our database of prospective data of 1873 consecutive patients who underwent minimally invasive mitral surgery from 2003 to 2015. To establish an unbiased definition of risk cut-off, we considered as high-risk the 'outliers of risk' identified using boxplot analysis in relation to EuroSCORE II. RESULTS: Two hundred and five patients were outliers, with 98 as minor (EuroSCORE II ≥ 6%) and 107 as major outliers (EuroSCORE II ≥ 9%). Outliers accounted for several different comorbidities. Nineteen patients died while in hospital (9.2%); different postoperative complications were observed. Outliers had a significantly lower mean survival time and a higher risk of cardiac-related death than the general population; however, the worst outcomes were observed in major outliers. No statistically significant difference was found with regard to the need for mitral reintervention and the degree of mitral regurgitation at follow-up. CONCLUSIONS: Boxplot analysis helped to achieve an internal definition of risk cut-off, starting from EuroSCORE II ≥ 6%. Minimally invasive mitral surgery in these outliers of risk was associated with acceptable early and long-term results; however, major outliers with EuroSCORE II ≥ 9% may benefit from catheter-based procedures.
Burns EM, Pettengell C, Athanasiou T, et al., 2016, Understanding The Strengths And Weaknesses Of Public Reporting Of Surgeon-Specific Outcome Data, HEALTH AFFAIRS, Vol: 35, Pages: 415-421, ISSN: 0278-2715
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- Citations: 31
Moscarelli M, Fattouch K, Casula R, et al., 2016, What Is the Role of Minimally Invasive Mitral Valve Surgery in High-Risk Patients? A Meta-Analysis of Observational Studies, ANNALS OF THORACIC SURGERY, Vol: 101, Pages: 981-989, ISSN: 0003-4975
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- Citations: 55
Soylu E, Harling L, Ashrafian H, et al., 2016, A systematic review of the safety and efficacy of distal coronary artery anastomotic devices, EUROPEAN JOURNAL OF CARDIO-THORACIC SURGERY, Vol: 49, Pages: 732-745, ISSN: 1010-7940
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- Citations: 9
Tan A, Ashrafian H, Scott AJ, et al., 2016, Robotic surgery: disruptive innovation or unfulfilled promise? A systematic review and meta-analysis of the first 30 years, Surgical Endoscopy and Other Interventional Techniques, Vol: 30, Pages: 4330-4352, ISSN: 1432-2218
Background Robotic surgery has been in existence for30 years. This study aimed to evaluate the overall perioperativeoutcomes of robotic surgery compared with opensurgery (OS) and conventional minimally invasive surgery(MIS) across various surgical procedures.Methods MEDLINE, EMBASE, PsycINFO, and ClinicalTrials.govwere searched from 1990 up to October 2013with no language restriction. Relevant review articles werehand-searched for remaining studies. Randomised controlledtrials (RCTs) and prospective comparative studies(PROs) on perioperative outcomes, regardless of patientage and sex, were included. Primary outcomes were bloodloss, blood transfusion rate, operative time, length of hospitalstay, and 30-day overall complication rate.Results We identified 99 relevant articles (108 studies,14,448 patients). For robotic versus OS, 50 studies (11 RCTs,39 PROs) demonstrated reduction in blood loss [ratio of means(RoM) 0.505, 95 % confidence interval (CI) 0.408–0.602],transfusion rate [risk ratio (RR) 0.272, 95 % CI 0.165–0.449],length of hospital stay (RoM 0.695, 0.615–0.774), and 30-dayoverall complication rate (RR 0.637, 0.483–0.838) in favour ofrobotic surgery. For robotic versus MIS, 58 studies (21 RCTs,37 PROs) demonstrated reduced blood loss (RoM 0.853,0.736–0.969) and transfusion rate (RR 0.621, 0.390–0.988) infavour of robotic surgery but similar length of hospital stay(RoM 0.982, 0.936–1.027) and 30-day overall complicationrate (RR 0.988, 0.822–1.188). In both comparisons, roboticsurgery prolonged operative time (OS: RoM 1.073,1.022–1.124; MIS: RoM 1.135, 1.096–1.173). The benefits ofrobotic surgery lacked robustness on RCT-sensitivity analyses.However, many studies, including the relatively fewavailable RCTs, suffered from high risk of bias and inadequatestatistical power.Conclusions Our results showed that robotic surgerycontributed positively to some perioperative outcomes butlonger operative times rem
Ashrafian H, Athanasiou T, Nicholson JK, et al., 2016, Unmet Medical Needs, Metabolic Phenotyping in Personalized and Public Healthcare, Pages: 1-15, ISBN: 9780128003442
Despite dramatic strides in health care, there are persistent and far-reaching medical needs that remain unmet. These include challenges in disease management, health care technology, socioeconomics, and health processes. These should be considered in a context of shifting pathology, where global trends in communicable and noncommunicable diseases remain in flux. Personalized Medicine can potentially address many of these persistent needs. We define this as the tailored management and/or prevention of disease according to the specific characteristics of a stratified individual, subpopulation, or population to enhance patient care. These characteristics are derived from the integrated evaluation of phenotype, genotype, and treatment bioresponses realized through a systems biomedicine "-omics" approach. This employs complex multivariate, network, and hierarchical computation in the context of best evidence-based practice. It offers precision in diagnosis and treatments, in addition to the generation of targeted therapeutics. This approach may offer novel strategies in addressing future unmet medical needs.
Kaufman N, Khurana I, 2016, Using Digital Health Technology to Prevent and Treat Diabetes., Diabetes Technol Ther, Vol: 18 Suppl 1, Pages: S56-S68
Jarral OA, Kidher E, Patel VM, et al., 2016, Quality of life after intervention on the thoracic aorta, EUROPEAN JOURNAL OF CARDIO-THORACIC SURGERY, Vol: 49, Pages: 369-389, ISSN: 1010-7940
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- Citations: 19
Wong KA, Pardy C, Pillay S, et al., 2016, Can the Presence of Crystalluria Predict Stone Formation in Patients with Cystinuria?, Journal of Endourology, Vol: 30, Pages: 609-614, ISSN: 1557-900X
OBJECTIVES: To determine the feasibility of crystalluria as a biomarker for stone disease in patients with cystinuria. PATIENTS AND METHODS: All patients attending a multidisciplinary cystinuria clinic provided early morning urine (EMU) and clinic urine (CU) samples for crystal measurement over a 2-year period (August 1, 2010, to July 31, 2012). Association between presence of crystals, presence of stone(s), and new stone growth (NSG) was determined using the chi-square test. Crystal numbers in EMU and CU were compared in patients with stones/NSG and no stones/stable disease using the Mann-Whitney U test. RESULTS: There was a statistically significant difference between the presence of crystalluria and presence of stones for CU (chi-square test = 5.86, df = 1, p = 0.02) but not EMU (chi-square test = 1.92, df = 1, p = 0.17) and between the presence of crystalluria and NSG for CU (chi-square test = 8.10, df = 1, p = 0.004) but not EMU (chi-square test = 1.32, df = 1, p = 0.25). Patients with stones and NSG have higher levels of crystalluria in CU than patients with no stones or stable disease (stones, median = 41, interquartile range [IQR] = 600 vs median = 0, IQR = 21, p = 0.01; NSG, median = 49, IQR = 525 vs median = 0, IQR = 40, p = 0.01). CONCLUSION: The presence of crystalluria in CU samples is associated with the presence of stones. Crystalluria is comparable to ultrasound and may serve as a useful adjunct to predict whether a patient with cystinuria has stones, which could guide the frequency of clinic review and imaging.
Chaudhry UAR, Harling L, Ashrafian H, et al., 2016, Surgical management of infected cardiac implantable electronic devices, INTERNATIONAL JOURNAL OF CARDIOLOGY, Vol: 203, Pages: 714-721, ISSN: 0167-5273
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- Citations: 8
Attia RQ, Hickey GL, Grant SW, et al., 2016, Minimally invasive versus conventional aortic valve replacement: a propensity-matched study from the UK National Data, Innovations, Vol: 11, Pages: 15-23, ISSN: 0095-4519
OBJECTIVE: Minimally invasive aortic valve replacement (MIAVR) has been demonstrated as a safe and effective option but remains underused. We aimed to evaluate outcomes of isolated MIAVR compared with conventional aortic valve replacement (CAVR). METHODS: Data from The National Institute for Cardiovascular Outcomes Research (NICOR) were analyzed at seven volunteer centers (2006-2012). Primary outcomes were in-hospital mortality and midterm survival. Secondary outcomes were postoperative length of stay as well as cumulative bypass and cross-clamp times. Propensity modeling with matched cohort analysis was used. RESULTS: Of 307 consecutive MIAVR patients, 151 (49%) were performed during the last 2 years of study with a continued increase in numbers. The 307 MIAVR patients were matched on a 1:1 ratio. In the matched CAVR group, there was no statistically significant difference in in-hospital mortality [MIAVR, 4/307,(1.3%); 95% confidence interval (CI), 0.4%-3.4% vs CAVR, 6/307 (2.0%); 95% CI, 0.8%-4.3%; P = 0.752]. One-year survival rates in the MIAVR and CAVR groups were 94.4% and 94.6%, respectively. There was no statistically significant difference in midterm survival (P = 0.677; hazard ratio, 0.90; 95% CI, 0.56-1.46). Median postoperative length of stay was lower in the MIAVR patients by 1 day (P = 0.009). The mean cumulative bypass time (94.8 vs 91.3 minutes; P = 0.333) and cross-clamp time (74.6 vs 68.4 minutes; P = 0.006) were longer in the MIAVR group; however, this was significant only in the cross-clamp time comparison. CONCLUSIONS: Minimally invasive aortic valve replacement is a safe alternative to CAVR with respect to operative and 1-year mortality and is associated with a shorter postoperative stay. Further studies are required in high-risk (logistic EuroSCORE > 10) patients to define the role of MIAVR.
Schrey D, Lechon FC, Malietzis G, et al., 2016, Multimodal therapy in children and adolescents with newly diagnosed atypical teratoid rhabdoid tumor: individual pooled data analysis and review of the literature, Journal of Neuro-Oncology, Vol: 126, Pages: 81-90, ISSN: 1573-7373
Atypical teratoid rhabdoid tumour (ATRT) is a malignant tumour of the central nervous system with a dismal prognosis. There is no consensus on optimal treatment and different multimodal strategies are currently being used in an attempt to improve outcomes. To evaluate the impact of high-dose chemotherapy followed by autologous stem-cell rescue (HD48 SCR), radiotherapy (RT) at first line, intrathecal chemotherapy (IT) and extent of surgical resection upon recurrence-free survival (RFS) and overall survival (OS). An online database search identified prospective and retrospective studies focused on the treatment of children and adolescents with newly diagnosed ATRT. Clinical, therapeutic and outcome data were extracted and an individual pooled data analysis was conducted. Out of 389 publications, 12 manuscripts were included in our review. Data from 332 patients were analysed. Median age at diagnosis was 37 months (range 1–231). HD-SCR, RT and IT had been administered to 28.6 % (58/203), 49.6 % (118/238) and 21 % (65/310) of the patients, respectively. Gross total resection (GTR) had been achieved in 46.5 % (152/327) of the cases. In the multivariate analysis, hazard ratios (95 % Confidence Interval) for HD-SCR were: RFS-HR = 0.570 (0.357–0.910) p = 0.019, and OS-HR = 0.388 (0.214–0.704) p = 0.002; and for RT: RFS-HR = 0.551 (0.351–0.866) p = 0.01, and OS-HR = 0.393 (0.216–0.712) p = 0.002. IT and GTR were not significantly associated with improved RFS or OS in the multivariate analysis. In our pooled data review, HD-SCR and RT at first line were associated with improved outcomes in children and adolescents with newly diagnosed ATRT.
Bouras G, Burns EM, Howell A, et al., 2015, Risk of Post-Discharge Venous Thromboembolism and Associated Mortality in General Surgery: A Population-Based Cohort Study Using Linked Hospital and Primary Care Data in England, PLOS One, ISSN: 1932-6203
Ashrafian H, Harling L, Toma T, et al., 2015, Type 1 diabetes mellitus and bariatric surgery: a systematic review and meta-analysis, Obesity Surgery, Vol: 26, Pages: 1697-1704, ISSN: 1708-0428
BackgroundType 1 diabetes mellitus (T1DM) has a rising global prevalence. Although it is vastly outnumbered by type 2 diabetes mellitus rates, it remains a persistent worldwide source of morbidity and mortality. Increasingly, its sufferers are afflicted by obesity and its complications. The objective of the study is to quantify the effects of bariatric surgery on T1DM by appraising the primary outcomes of glycosylated haemoglobin (HbA1c), insulin requirements and body mass index (BMI). Secondary outcomes included blood pressure, triglycerides and cholesterol biochemistry.MethodsA systematic review of studies reporting pre-operative and post-operative outcomes in T1DM patients undergoing bariatric surgery was done. Data were meta-analysed using random effects modelling. Subgroup analysis and quality scoring were assessed.ResultsBariatric surgery in obese T1DM patients is associated with a significant reduction in insulin requirement (−48.95 units, 95 % CI of −56.27, −41.62), insulin requirement per kilogramme (−0.391, 95 % CI of −0.51, −0.27), HbA1c (−0.933, 95 % CI of −1.604, −0.262) and BMI (−11.04 kg/m2, 95 % CI of −13.49, −8.59). Surgery is also associated with a statistically significant reduction in systolic and diastolic blood pressure and a significant beneficial rise in HDL. Heterogeneity in these results was high, and study quality was low overall.ConclusionsBariatric surgery in obese T1DM patients is associated with a significant improvement in insulin requirement and a significant though modest effect on HbA1c. These early results require further substantiation with future studies focusing on higher levels of evidence. This may offer a deeper understanding of diabetogenesis and can contribute to better selection and stratification of diabetic patients for metabolic surgery and future metabolic treatment strategies.
Protopapas AD, Ashrafian H, Athanasiou T, 2015, Tumour thrombi in the cavae, Charing Cross Symposium 2016
BACKGROUND: Renal cell carcinomas and other retroperitoneal tumours propagate tumour thrombi in the inferior vena cava, often well into the thorax. These intrathoracic caval tumour thrombi (ICTT) are of interest to the cardiothoracic surgeon: We consider two ICTT subgroups that correspond to the wider ‘Neves and Zincke’ classification: ICTT-III (extracardiac) extending just above the hepatic veins and ICTT-IV (intracardiac). METHODS: Review of case series for evidence on the peri-operative management of ICTT.RESULTS: We identified and retained for data extraction 29 series with 784 patients, 453 cases of extracardiac and 331 of intracardiac tumour thrombi. Average age was 59 years. 98% of the tumours were RCC, 1% adrenal and Wilms’ tumours and 1% transitional cell carcinomas.The prevalent incision was chevron (rooftop) with or without tandem sternotomy. Mortality was 10% (5% for ICTT-III, 15% for ICTT-IV). Morbidity was 56% (36% for ICTT-III, 64% for ICTT-IV). Bleeding necessitating reoperation was the commonest complication (14%). The transfusion requirements reflected the estimated blood loss: 2.6 Litres of blood loss and 2.4 Litres of blood products for the ICTT-III subgroup and 3.7 Litres of blood loss and 3.5 Litres of blood products for ICTT-IV. Operative and anaesthetic times exceeded 5 hours Hospital stay averaged 13 days. Variations in perioperative care included: pre-operative embolisation, peri-operative transoesophageal echo, surgical incisions and use of extracorporeal circulation (perfusion).CONCLUSIONS: -Surgery for ICTT is resource-intensive. -It requires provision for massive transfusion and prolonged in-hospital recovery times.
Sepehripour AH, Athanasiou T, 2015, Developments in surgical revascularization to achieve improved morbidity and mortality., Expert Review of Cardiovascular Therapy, Vol: 14, Pages: 367-379, ISSN: 1477-9072
Coronary artery bypass graft surgery remains the main treatment modality for multivessel coronary artery disease and has consistently been demonstrated to have significantly lower rates of major adverse cardiac and cerebrovascular events in comparison to percutaneous coronary intervention. In this article we will explore the advances over time and the recent refinements in the techniques of surgical revascularization and how these contribute to the superior outcome profile associated with coronary artery bypass graft surgery. These include the current outcome status of coronary artery bypass grafting; the major landmark trials, registries and meta-analyses comparing coronary artery bypass grafting and percutaneous coronary intervention; the developments in coronary artery disease lesion classification; the techniques for the physiological assessment of coronary artery lesions; bypass grafting using arterial conduits; the role of off-pump coronary artery surgery; the outcomes of reoperative surgery; hybrid techniques for coronary revascularization; minimally invasive coronary artery surgery and finally robotic surgery.
Howell AR, burns EM, Bouras G, et al., 2015, Can Patient Safety Incident Reports Be Used to Compare Hospital Safety? Results from a Quantitative Analysis of the English National Reporting and Learning System Data., PLOS One, Vol: 10, ISSN: 1932-6203
BackgroundThe National Reporting and Learning System (NRLS) collects reports about patient safety incidents in England. Government regulators use NRLS data to assess the safety of hospitals.This study aims to examine whether annual hospital incident reporting rates can be used as a surrogate indicator of individual hospital safety. Secondly assesses which hospital characteristics are correlated with high incident reporting rates and whether a high reporting hospital is safer than those lower reporting hospitals. Finally, it assesses whichhealth-care professionals report more incidents of patient harm, which report more near miss incidents and what hospital factors encourage reporting. These findings may suggest methods for increasing the utility of reporting systems.MethodsThis study used a mix methods approach for assessing NRLS data. The data were investigated using Pareto analysis and regression models to establish which patients are most vulnerable to reported harm. Hospital factors were correlated with institutional reporting rates over one year to examine what factors influenced reporting. Staff survey findings regardinghospital safety culture were correlated with reported rates of incidents causing harm; no harm and death to understand what barriers influence error disclosure.Findings5,879,954 incident reports were collected from acute hospitals over the decade. 70.3%of incidents produced no harm to the patient and 0.9% were judged by the reporter to have caused severe harm or death. Obstetrics and Gynaecology reported the most no harmevents [OR 1.61(95%CI: 1.12 to 2.27), p<0.01] and pharmacy was the hospital location where most near-misses were captured [OR 3.03(95%CI: 2.04 to 4.55), p<0.01]. Clinicians were significantly more likely to report death than other staff [OR 3.04(95%CI: 2.43 to 3.80)p<0.01]. A higher ratio of clinicians to beds correlated with reduced rate of harm reported [RR = -1.78(95%Cl: -3.33 to -0.23), p = 0.03]. Litigation claims
Pannick S, Sevdalis N, Athanasiou T, 2015, Beyond clinical engagement: a pragmatic model for quality improvement interventions, aligning clinical and managerial priorities, BMJ Quality & Safety, Vol: 25, Pages: 716-725, ISSN: 2044-5423
Despite taking advantage of established learning from other industries, quality improvementinitiatives in healthcare may struggle to outperform secular trends. The reasons for this arerarely explored in detail, and are often attributed merely to difficulties in engaging cliniciansin quality improvement work. In a narrative review of the literature, we argue that this focuson clinicians, at the relative expense of managerial staff, has proven counterproductive.Clinical engagement is not a universal challenge; moreover, there is evidence that managers– particularly middle managers – also have a role to play in quality improvement. Yetmanagerial participation in quality improvement interventions is often assumed, rather thanproven. We identify specific factors that influence the coordination of frontline staff andmanagers in quality improvement, and integrate these factors into a novel model: the modelof alignment. We use this model to explore the implementation of an interdisciplinaryintervention in a recent trial, describing different participation incentives and barriers fordifferent staff groups. The extent to which clinical and managerial interests align may be animportant determinant of the ultimate success of quality improvement interventions.
Bower G, Toma T, Harling L, et al., 2015, Bariatric Surgery and Non-Alcoholic Fatty Liver Disease: a Systematic Review of Liver Biochemistry and Histology, OBESITY SURGERY, Vol: 25, Pages: 2280-2289, ISSN: 0960-8923
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- Citations: 153
Chaudhry UAR, Harling L, Sepehripour AH, et al., 2015, Beating-Heart Versus Conventional On-Pump Coronary Artery Bypass Grafting: A Meta-Analysis of Clinical Outcomes, ANNALS OF THORACIC SURGERY, Vol: 100, Pages: 2251-2261, ISSN: 0003-4975
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- Citations: 27
Nguyen BAV, Fiorentino F, Reeves BC, et al., 2015, Mini Bypass and Proinflammatory Leukocyte Activation: A Randomized Controlled Trial, Annals of Thoracic Surgery, Vol: 101, Pages: 1454-1463, ISSN: 1552-6259
Malietzis G, Mughal A, Currie AC, et al., 2015, Factors Implicated for Delay of Adjuvant Chemotherapy in Colorectal Cancer: A Meta-analysis of Observational Studies, ANNALS OF SURGICAL ONCOLOGY, Vol: 22, Pages: 3793-3802, ISSN: 1068-9265
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- Citations: 50
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