Publications
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Modi HN, SIngh H, Orihuela-Espina F, et al., 2017, Temporal stress in the operating room: brain engagement promotes "coping" and disengagement prompts "choking", Annals of Surgery, Vol: 267, Pages: 683-691, ISSN: 1528-1140
Objective:To investigate the impact of time pressure (TP) on prefrontalactivation and technical performance in surgical residents during a laparo-scopic suturing task.Background:Neural mechanisms enabling surgeons to maintain perform-ance and cope with operative stressors are unclear. The prefrontal cortex(PFC) is implicated due to its role in attention, concentration, and perform-ance monitoring.Methods:A total of 33 residents [Postgraduate Year (PGY)1 – 2¼15,PGY3– 4¼8, and PGY5¼10] performed a laparoscopic suturing taskunder ‘‘self-paced’’ (SP) and ‘‘TP’’ conditions (TP¼maximum 2 minutes perknot). Subjective workload was quantified using the Surgical Task LoadIndex. PFC activation was inferred using optical neuroimaging. Technicalskill was assessed using progression scores (au), error scores (mm), leakvolumes (mL), and knot tensile strengths (N).Results:TP led to greater perceived workload amongst all residents (meanSurgical Task Load Index score SD: PGY1 – 2: SP¼160.3 24.8 vs TP¼202.1 45.4,P<0.001; PGY3 – 4: SP¼123.0 52.0 vs TP¼172.5 43.1,P<0.01; PGY5: SP¼105.8 55.3 vs TP¼159.1 63.1,P<0.05).Amongst PGY1– 2 and PGY3– 4, deterioration in task progression, errorscores and knot tensile strength (P<0.05), and diminished PFC activationwas observed under TP. In PGY5, TP resulted in inferior task progression anderror scores (P<0.05), but preservation of knot tensile strength. Furthermore,PGY5 exhibited less attenuation of PFC activation under TP, and greateractivation than either PGY1 – 2 or PGY3 – 4 under both experimental con-ditions (P<0.05).Conclusions:Senior residents cope better with temporal demands and exhibitgreater technical performance stability under pressure, possibly due to
Soylu E, Athanasiou T, Jarral OA, 2017, Vivien Theodore Thomas (1910-1985): An African-American laboratory technician who went on to become an innovator in cardiac surgery, JOURNAL OF MEDICAL BIOGRAPHY, Vol: 25, Pages: 106-113, ISSN: 0967-7720
Askari A, Nachiappan S, Currie A, et al., 2017, Who requires emergency surgery for colorectal cancer and can national screening programmes reduce this need?, INTERNATIONAL JOURNAL OF SURGERY, Vol: 42, Pages: 60-68, ISSN: 1743-9191
Pannick SAJ, Archer S, Johnston MJ, et al., 2017, Translating concerns into action: a detailed qualitative evaluation of an interdisciplinary intervention on medical wards, BMJ Open, Vol: 7, ISSN: 2044-6055
ObjectivesTo understand how frontline reports of day-to-day care failings might be better translated into improvement.DesignQualitative evaluation of an interdisciplinary team intervention to capitalise on the frontline experience of care delivery. Prospective clinical team surveillance (PCTS) involved structured interdisciplinary briefings to capture challenges in care delivery, facilitated organisational escalation of the issues they identified, and feedback. Eighteen months of ethnography and two focus groups were conducted with staff taking part in a trial of PCTS.ResultsPCTS fostered psychological safety – a confidence that the team would not embarrass or punish those who speak up. This was complemented by a hard edge of accountability, whereby team members would regulate their own behaviour in anticipation of future briefings. Frontline concerns were triaged to managers, or resolved autonomously by ward teams, reversing what had been well-established normalisations of deviance. Junior clinicians found a degree of catharsis in airing their concerns, and their teams became more proactive in addressing improvement opportunities. PCTS generated tangible organisational changes, and enabled managers to make a convincing case for investment. However, briefings were constrained by the need to preserve professional credibility, and the relative comfort afforded by the avoidance of accountability. At higher organisational levels, frontline concerns were subject to competition with other priorities, and their resolution was limited by the scale of the challenges they described.ConclusionsProspective safety strategies relying on staff-volunteered data do approximate the realities of frontline care, but still produce acceptable, negotiated accounts, subject to the many interdisciplinary tensions that characterise ward work. Nonetheless, they give managers access to these accounts, and support frontline staff to make incremental changes in their daily work. These are
Bower G, Ashrafian H, Cappelletti S, et al., 2017, A proposed role for sepsis in the pathogenesis of myocardial calcification, ACTA CARDIOLOGICA, Vol: 72, Pages: 249-255, ISSN: 0001-5385
Barr J, Kokotsakis J, Velissarios K, et al., 2017, Is the thoracic aorta a safe site for the proximal anastomosis for bypassing the mesenteric arteries in patients with chronic mesenteric ischaemia?, Interactive Cardiovascular and Thoracic Surgery, Vol: 24, Pages: 796-798, ISSN: 1569-9293
A best evidence topic in cardiovascular surgery was written according to a structured protocol. The question addressed was whether the thoracic aorta is a safe site for the proximal anastomosis when bypassing the mesenteric arteries in patients with chronic mesenteric ischaemia. Five articles reported the use of the thoracic aorta as the site of proximal anastomosis in 35 patients with chronic mesenteric ischaemia. All of these studies were retrospective case reports or case series. The ascending aorta was the site for the proximal anastomosis in 7 patients with the descending thoracic aorta being used in the other 28 patients. The ascending aorta was used when there was disease of the descending thoracic aorta. Out of the 35 patients there was only 1 perioperative death (3%). Rates of graft patency and freedom from recurrent symptoms were excellent. The published literature supports the use of the thoracic aorta as an option for the site of the proximal anastomosis when bypass from elsewhere is not possible.
Askari A, Nachiappan S, Currie A, et al., 2017, The relationship between ethnicity, social deprivation and late presentation of colorectal cancerle, CANCER EPIDEMIOLOGY, Vol: 47, Pages: 88-93, ISSN: 1877-7821
Pantelidis P, Sideris M, Tsoulfas G, et al., 2017, Is In-Vivo laparoscopic simulation learning a step forward in the Undergraduate Surgical Education?, Annals of Medicine and Surgery, Vol: 16, Pages: 52-56, ISSN: 2049-0801
BACKGROUND: Essentials Skills in the Management of Surgical Cases - ESMSC is an International Combined Applied Surgical Science and Wet Lab course addressed at the Undergraduate level. Laparoscopic Skills is a fundamental element of Surgical Education and various Simulation-Based Learning (SBL) models have been endorsed. This study aims to explore if there is any significant difference in delegates' performance depending on whether they completed In Vivo module prior to the equivalent in the laparoscopic simulator. MATERIALS AND METHODS: 37 Medical Students from various EU countries were divided in 2 groups, and both completed the "Fundamentals in Laparoscopic Surgery" module in the Dry-lab Laparoscopic Simulator as well as the same module "In Vivo" on a swine model. Group A (18 students, 48.6%) completed the "Fundamentals in Laparoscopic Surgery - FLS" module prior to the "In Vivo", whereas group B completed the "In Vivo" module first. Direct Observation of Procedural Skills (DOPS) were used to assess delegates' performance. RESULTS: The mean DOPS scores for the "FLS" and "In Vivo" models were 2.27 ± 0.902 and 2.03 ± 0.833, respectively, and the delegates' performance was not statistically significantly different between them (p = 0.128). There was no statistically significant difference in the scores among different gender, year of study, school and handedness groups. The alteration in the sequence between Dry-lab "FLS" and "In Vivo" modules did not affect the performance in neither the "FLS" nor the "In Vivo" models. CONCLUSIONS: The inexpensive, but low-fidelity "FLS" model could serve an equal alternative Simulation-Based Learning model for the early undergraduate training. Our study demonstrated that high fidelity In Vivo simulation for laparoscopic skills doe
Athanasopoulos LV, Athanasiou T, 2017, Are virtual clinics an applicable model for service improvement in cardiac surgery?, European Journal of Cardio-Thoracic Surgery, Vol: 51, Pages: 201-202, ISSN: 1010-7940
Leff DR, Yongue G, Vlaev I, et al., 2017, "Contemplating the next maneuver": functional neuroimaging reveals intraoperative decision-making strategies, Annals of Surgery, Vol: 265, Pages: 320-330, ISSN: 1528-1140
OBJECTIVE: To investigate differences in the quality, confidence, and consistency of intraoperative surgical decision making (DM) and using functional neuroimaging expose decision systems that operators use. SUMMARY BACKGROUND DATA: Novices are hypothesized to use conscious analysis (effortful DM) leading to activation across the dorsolateral prefrontal cortex, whereas experts are expected to use unconscious automation (habitual DM) in which decisions are recognition-primed and prefrontal cortex independent. METHODS: A total of 22 subjects (10 medical student novices, 7 residents, and 5 attendings) reviewed simulated laparoscopic cholecystectomy videos, determined the next safest operative maneuver upon video termination (10 s), and reported decision confidence. Video paradigms either declared ("primed") or withheld ("unprimed") the next operative maneuver. Simultaneously, changes in cortical oxygenated hemoglobin and deoxygenated hemoglobin inferring prefrontal activation were recorded using Optical Topography. Decision confidence, consistency (primed vs unprimed), and quality (script concordance) were assessed. RESULTS: Attendings and residents were significantly more certain (P < 0.001), and decision quality was superior (script concordance: attendings = 90%, residents = 78.3%, and novices = 53.3%). Decision consistency was significantly superior in experts (P < 0.001) and residents (P < 0.05) than novices (P = 0.183). During unprimed DM, novices showed significant activation of the dorsolateral prefrontal cortex, whereas this activation pattern was not observed among residents and attendings. During primed DM, significant activation was not observed in any group. CONCLUSIONS: Expert DM is characterized by improved quality, consistency, and confidence. The findings imply attendings use a habitual decision system, whereas novices use an effortful approach under uncertainty. In the presence of operative cues (primes), novices disengage
Pinto C, Garas G, Harling L, et al., 2017, Is endovascular treatment with multilayer flow modulator stent insertion a safe alternative to open surgery for high-risk patients with thoracoabdominal aortic aneurysm?, Annals of Medicine and Surgery, Vol: 15, Pages: 1-8, ISSN: 2049-0801
A best evidence topic in cardiothoracic and vascular surgery was written according to a structured protocol. The question addressed was whether endovascular treatment with multilayer flow modulator stents (MFMS) can be considered a safe alternative to open surgery for high-risk patients with thoracoabdominal aortic aneurysm (TAAA). Altogether 27 papers were identified using the reported search, of which 11 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes, results, and study limitations are tabulated. The outcomes of interest were all-cause survival, aneurysm-related survival, branch vessel patency and major adverse events. Aneurysm-related survival exceeded 78% in almost all studies, with the exception of one where the MFMS was inserted outside the instructions for use. In that study the aneurysm-related survival was 28.9%. The branch vessel patency was higher than 95% in 10 studies and not reported in one. At 12-month follow-up, several studies showed a low incidence of major adverse events, including stroke, paraplegia and aneurysm rupture. We conclude that MFMS represent a suitable and safe treatment for high-risk patients with TAAA maintaining branch vessel patency when used within their instructions for use. However, a number of limitations must be considered when interpreting this evidence, particularly the complete lack of randomised controlled trials (RCTs), short follow-up in all studies, and heterogeneity of the pathologies among the different populations studied. Further innovative developments are needed to improve MFMS safety, expand their instructions for use, and enhance their efficacy.
Bouras G, Burns EM, Howell AM, et al., 2017, Linked hospital and primary care database analysis of the impact of short-term complications on recurrence in laparoscopic inguinal hernia repair, HERNIA, Vol: 21, Pages: 191-198, ISSN: 1265-4906
Objective:To study the effects of short-term complications on recurrence following laparoscopic inguinal hernia repair using routine data.Background:Linked primary and secondary care databases can evaluate the quality of inguinal hernia surgery by quantifying short- and long-term outcome together.Methods:Longitudinal analysis of linked primary care (Clinical Practice Research Datalink) and hospital administrative (Hospital Episodes Statistics) databases quantified 30-day complications (wound infection and bleeding) and surgery for recurrence after primary repair performed between 1st April 1997 and 31st March 2012.Results:Out of 41,545 primary inguinal hernia repairs, 10.3% (4296/41,545) were laparoscopic. Complications were less frequent following laparoscopic (1.8%, 78/4296) compared with open (3.5%, 1288/37,249) inguinal hernia repair (p < 0.05). Recurrence was more frequent following laparoscopic (3.5%, 84/2541) compared with open (1.2%, 366/31,859) repair (p < 0.05). Time to recurrence was shorter for laparoscopic (26.4 months SD 28.5) compared with open (46.7 months SD 37.6) repair (p < 0.05). Overall, complications were associated with recurrence (3.2%, 44/1366 with complications; 1.7%, 700/40,179 without complications; p < 0.05). Complications did not significantly increase the risk of recurrence in open hernia repair (OR = 1.49; 95% CI 0.97−2.30, p = 0.069). Complications following laparoscopic repair was significantly associated with increased risk of recurrence (OR = 7.86; 95% CI 3.46−17.85, p < 0.05).Conclusions:Complications recorded in linked routine data predicted recurrence following laparoscopic inguinal hernia repair. Focus must, therefore, be placed on achieving good short-term outcome, which is likely to translate to better longer term results using the laparoscopic approach.
Abdullahi YS, Athanasopoulos LV, Casula RP, et al., 2017, Systematic review on the predictive ability of frailty assessment measures in cardiac surgery., Interactive Cardiovascular and Thoracic Surgery, Vol: 24, Pages: 619-624, ISSN: 1569-9293
OBJECTIVES: Patient frailty is increasingly recognised as contributing to adverse postoperative outcomes in cardiothoracic surgery. The goal of this review is to evaluate the predictive ability of frailty scoring systems and their limitations in risk assessment of patients undergoing cardiac surgery. METHODS: Frailty studies were identified by searching electronic databases. Studies in which the measuring instrument was defined as a multidimensional tool focusing on a population undergoing cardiac operations were included. The focus was on the predictive ability of frailty in this population and a comparison with conventional risk scoring systems. Unfortunately, the lack of a significant number of studies with the same postoperative outcome precluded a formal meta-analysis. RESULTS: Of 783 studies identified in our initial search, 6 fulfilled our inclusion criteria. Frailty was identified as a predictor of mortality, morbidity and/or prolonged hospital stay in patients undergoing cardiac surgery. Our systematic review revealed the increased application of frailty scores compared to standardized risk stratification scores in cardiothoracic patients. In approximately 50% of these studies, frailty scores continued to be predictive even after adjusting for the conventional risk scoring systems. CONCLUSIONS: The assessment of frailty may enhance the preoperative workup and offer an optimized risk stratification measure in patients undergoing cardiothoracic procedures even though the reporting standards of calibration and classification measures have been relatively poor.
Abdullahi Y, Athanasiou T, Leonidas A, et al., 2017, Systematic review on the predictive ability of frailty assessment measures in cardiac surgery
OBJECTIVES: Patient frailty is increasingly recognised as contributing to adverse postoperative outcomes in cardiothoracic surgery. The goal of this review is to evaluate the predictive ability of frailty scoring systems and their limitations in risk assessment of patients undergoing cardiac surgery.METHODS: Frailty studies were identified by searching electronic databases. Studies in which the measuring instrument was defined as a multidimensional tool focusing on a population undergoing cardiac operations were included. The focus was on the predictive ability of frailty in this population and a comparison with conventional risk scoring systems. Unfortunately, the lack of a significant number of studies with the same postoperative outcome precluded a formal meta-analysis.RESULTS: Of 783 studies identified in our initial search, 6 fulfilled our inclusion criteria. Frailty was identified as a predictor of mortality, morbidity and/or prolonged hospital stay in patients undergoing cardiac surgery. Our systematic review revealed the increased application of frailty scores compared to standardized risk stratification scores in cardiothoracic patients. In approximately 50% of these studies, frailty scores continued to be predictive even after adjusting for the conventional risk scoring systems.CONCLUSIONS: The assessment of frailty may enhance the preoperative workup and offer an optimized risk stratification measure in patients undergoing cardiothoracic procedures even though the reporting standards of calibration and classification measures have been relatively poor.
Rao C, Myint AS, Athanasiou T, et al., 2017, Avoiding Radical Surgery in Elderly Patients With Rectal Cancer Is Cost-Effective, Diseases of the Colon and Rectum, Vol: 60, Pages: 30-42, ISSN: 0012-3706
BACKGROUND: Radical surgery is associated with significant perioperative mortality in elderly and comorbid populations. Emerging data suggest for patients with a clinical complete response after neoadjuvant chemoradiotherapy that a watch-and-wait approach may provide equivalent survival and oncological outcomes.OBJECTIVE: The purpose of this study was to compare the cost-effectiveness of watch and wait and radical surgery for patients with rectal cancer after a clinical complete response following chemoradiotherapy.DESIGN: Decision analytical modeling and a Markov simulation were used to model long-term costs, quality-adjusted life-years, and cost-effectiveness after watch and wait and radical surgery. Sensitivity analysis was used to investigate the effect of uncertainty in model parameters.SETTINGS: A third-party payer perspective was adopted.PATIENTS: Patients included in the study were a 60-year–old male cohort with no comorbidities, 80-year–old male cohorts with no comorbidities, and 80-year–old male cohorts with significant comorbidities.INTERVENTIONS: Radical surgery and watch-and-wait approaches were studied.MAIN OUTCOME MEASURES: Incremental cost, effectiveness, and cost-effectiveness ratio over the entire lifetime of the hypothetical patient cohorts were measured.RESULTS: Watch and wait was more effective (60-year–old male cohort with no comorbidities = 0.63 quality-adjusted life-years (95% CI, 2.48–3.65 quality-adjusted life-years); 80-year–old male cohort with no comorbidities = 0.56 quality-adjusted life-years (95% CI, 0.52–1.59 quality-adjusted life-years); 80-year–old male cohort with significant comorbidities = 0.72 quality-adjusted life-years (95% CI, 0.34–1.76 quality-adjusted life-years)) and less costly (60-year–old male cohort with no comorbidities = $11,332.35 (95% CI, $668.50–$23,970.20); 80-year–old male cohort with no comorbidities = $8783.93 (95% CI, $2504.26–$21
Erridge S, Pucher P, Markar S, et al., 2017, Determinants Of Outcome And Survival Following Treatment Of Recurrent Hepatocellular Carcinoma: A Systematic Review & Meta-Analysis, AHPBA 2017
Erridge S, Markar S, Malietzis G, et al., 2017, The role of hepatic resection in breast cancer liver metastases and identification of prognostic factors for survival: a systematic review and meta-analysis, AHPBA 2017
Manfield JH, Yu KK-H, Efthimiou E, et al., 2016, Bariatric surgery or non-surgical weight loss for idiopathic intracranial hypertension? A systematic review and comparison of meta-analyses, Obesity Surgery, Vol: 27, Pages: 513-521, ISSN: 0960-8923
Background:Idiopathic intracranial hypertension (IIH) is associated with obesity and weight loss by any means is considered beneficial in this condition.Objectives:This study aims to appraise bariatric surgery vs. non-surgical weight-loss (medical, behavioural and lifestyle) interventions in IIH management.Methods:A systematic review and meta-analyses of surgical and non-surgical studies.Results:Bariatric surgery achieved 100% papilloedema resolution and a reduction in headache symptoms in 90.2%. Non-surgical methods offered improvement in papilloedema in 66.7%, visual field defects in 75.4% and headache symptoms in 23.2%. Surgical BMI decrease was 17.5 vs. 4.2 for non-surgical methods.Conclusions:Whilst both bariatric surgery and non-surgical weight loss offer significant beneficial effects on IIH symptomatology, future studies should address the lack of prospective and randomised trials to establish the optimal role for these interventions.
Sideris MC, Papalois AE, Athanasiou T, et al., 2016, Evaluating the educational environment of an international animal model-based wet lab course for undergraduate students, ANNALS OF MEDICINE AND SURGERY, Vol: 12, Pages: 8-17, ISSN: 2049-0801
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Barr J, Kokotsakis J, Tsipas P, et al., 2016, Ascending Aorta to Hepatic and Mesenteric Artery Bypassing, in Patients with Chronic Mesenteric Ischemia and Extensive Aortic Disease-A Case Report and Review of the Literature., Ann Vasc Surg, Vol: 39, Pages: 292.e9-292.e15
Chronic mesenteric ischemia (CMI) is a rare disorder caused by severe stenosis of the mesenteric arterial supply that results in postprandial pain and weight loss. Treatment options are surgical or endovascular. Surgical bypass can be performed in an antegrade fashion from the supraceliac abdominal aorta (AA) or the distal descending thoracic aorta or in a retrograde fashion from the infrarenal aorta or the common iliac artery. However, in some patients with disease of the descending thoracic aorta or the AA, another site for the proximal anastomosis needs to be found. In this article, we report the case of a 69-year-old man with a thoracoabdominal aortic aneurysm and CMI in whom we performed bypass grafts to the hepatic and superior mesenteric arteries using the ascending aorta as the site for the proximal anastomoses via a median sternolaparotomy. In addition, we performed a literature review of all similar cases and provide an analysis of this technique and an assessment of the success rates.
Athanasopoulos LV, Athanasiou T, 2016, Off-pump coronary artery bypass grafting in left main stem stenosis: outcomes, concerns and controversies., J Thorac Dis, Vol: 8, Pages: S787-S794, ISSN: 2072-1439
Left main stem (LMS) disease is known to be a poor prognostic factor in terms of morbidity or mortality. Traditionally, it has been treated with constitution of bypass to provide required haemodynamic stability. We searched the literature for evidence on off-pump (OFP) surgery for treating this high-risk group of patients focusing in our review on postoperative outcomes, concerns and controversies. The majority of the studies identified showed favourable or equal outcomes of OFP when compared to conventional approach. All of the studies, apart from two, which showed lower incidence of postoperative deaths, demonstrated equal mortality rates. Stroke rates were found less in three studies. Less blood transfusions, inotropic use and length of study has been also demonstrated. The main concerns of OFP surgery are: haemodynamic instability and less complete revascularization. Main controversies are: same or favourable outcomes despite lower number of grafts with OFP surgery and less stroke rates despite manipulation of aorta with side-clamping. Despite these concerns and controversies OFP surgery has been proven to be feasible and safe as demonstrated by results from numerous studies.
Bouras G, Markar SR, Burns EM, et al., 2016, The psychological impact of symptoms related to esophagogastric cancer resection presenting in primary care: A national linked database study, European Journal of Surgical Oncology, Vol: 43, Pages: 454-460, ISSN: 1532-2157
BackgroundThe objective was to evaluate incidence, risk factors and impact of postoperative symptoms following esophagogastric cancer resection in primary care.MethodsPatients undergoing esophagogastrectomy for cancer from 1998 to 2010 with linked records in Clinical Practice Research Datalink, Hospital Episodes Statistics and Office of National Statistics databases were studied. The recording of codes for reflux, dysphagia, dyspepsia, nausea, vomiting, dumping, diarrhea, steatorrhea, appetite loss, weight loss, pain and fatigue were identified up to 12 months postoperatively. Psychiatric morbidity was also examined and its risk evaluated by logistic regression analysis.ResultsOverall, 58.6% (1029/1755) of patients were alive 2 years after surgery. Of these, 41.1% had recorded postoperative symptoms. Reflux, dysphagia, dyspepsia and pain were more frequent following esophagectomy compared with gastrectomy (p < 0.05). Complications (OR = 1.40 95%CI 1.00–1.95) and surgical procedure predicted postoperative symptoms (p < 0.05). When compared with partial gastrectomy, esophagectomy (OR = 2.03 95%CI 1.26–3.27), total gastrectomy (OR = 2.44 95%CI 1.57–3.79) and esophagogastrectomy (OR = 2.66 95%CI 1.85–2.86) were associated with postoperative symptoms (p < 0.05). The majority of patients with postoperative psychiatric morbidity had depression or anxiety (98%). Predictors of postoperative depression/anxiety included younger age (OR = 0.97 95%CI 0.96–0.99), complications (OR = 2.40 95%CI 1.51–3.83), psychiatric history (OR = 6.73 95%CI 4.25–10.64) and postoperative symptoms (OR = 1.78 95%CI 1.17–2.71).ConclusionsOver 40% of patients had symptoms related to esophagogastric cancer resection recorded in primary care, and were associated with an increase in postoperative depression and anxiety.
Liasis L, Malietzis G, Galyfos G, et al., 2016, The emerging role of microdialysis in diabetic patients undergoing amputation for limb ischemia, WOUND REPAIR AND REGENERATION, Vol: 24, Pages: 1073-1080, ISSN: 1067-1927
Currie AC, Malietzis G, Jenkins JT, et al., 2016, Network meta-analysis of protocol-driven care and laparoscopic surgery for colorectal cancer, BRITISH JOURNAL OF SURGERY, Vol: 103, Pages: 1783-1794, ISSN: 0007-1323
Tan MKH, Jarral OA, Thong EHE, et al., 2016, Quality of life after mitral valve intervention, Interactive Cardiovascular and Thoracic Surgery, Vol: 24, Pages: 265-272, ISSN: 1569-9293
Advancements in surgical technique and understanding of the pathophysiology of mitral valve (MV) dysfunction have led to improved outcomes. Seen as a development beyond measures of morbidity and mortality, health-related quality-of-life (HRQOL) outcome measures are becoming increasingly popular. These measures are important because complications following routine (i.e. low-risk) operations on the MV are uncommon and further markers of outcome are needed. Surgeons are increasingly operating earlier on asymptomatic patients and will need to prove that HRQOL is not impacted. Novel minimally invasive and transcatheter technologies will also need to demonstrate satisfactory HRQOL outcomes prior to widespread use. This systematic review provides an overview of all available literature detailing HRQOL in patients receiving MV interventions. In the 43 studies included, 6865 patients underwent procedures ranging from open replacement to percutaneous repair using devices such as the Mitraclip Clip Delivery System (MitraClip) (Abbott Vascular, Santa Clara, CA, USA). Most studies performed baseline HRQOL assessment, allowing postinterventional comparison. While the underlying literature had deficiencies, most studies report acceptable postintervention HRQOL that was comparable to that of matched general populations. Patient-specific (e.g. female gender, renal dysfunction) and surgical-specific factors (e.g. replacement instead of repair, elevated transmitral gradient) were identified that predispose patients to poorer long-term HRQOL outcomes. These factors are important for clinicians developing strategies to maximize their HRQOL outcomes. Future randomized studies would benefit from HRQOL measurements at specific time points to allow large-scale comparisons. Establishing a common HRQOL instrument for use in MV intervention studies may support detailed comparisons between specific techniques. Physical activity monitors, physiological biomarkers and radiological markers could a
Sabharwal S, Patel NK, Griffiths D, et al., 2016, Trials based on specific fracture configuration and surgical procedures likely to be more relevant for decision making in the management of fractures of the proximal humerus, Bone & Joint Research, Vol: 5, Pages: 470-480, ISSN: 2046-3758
Objectives The objective of this study was to perform a meta-analysis of all randomised controlled trials (RCTs) comparing surgical and non-surgical management of fractures of the proximal humerus, and to determine whether further analyses based on complexity of fracture, or the type of surgical intervention, produced disparate findings on patient outcomes.Methods A systematic review of the literature was performed identifying all RCTs that compared surgical and non-surgical management of fractures of the proximal humerus. Meta-analysis of clinical outcomes was performed where possible. Subgroup analysis based on the type of fracture, and a sensitivity analysis based on the type of surgical intervention, were also performed.Results Seven studies including 528 patients were included. The overall meta-analysis found that there was no difference in clinical outcomes. However, subgroup and sensitivity analyses found improved patient outcomes for more complex fractures managed surgically. Four-part fractures that underwent surgery had improved long-term health utility scores (mean difference, MD 95% CI 0.04 to 0.28; p = 0.007). They were also less likely to result in osteoarthritis, osteonecrosis and non/malunion (OR 7.38, 95% CI 1.97 to 27.60; p = 0.003). Another significant subgroup finding was that secondary surgery was more common for patients that underwent internal fixation compared with conservative management within the studies with predominantly three-part fractures (OR 0.15, 95% CI 0.04 to 0.63; p = 0.009).Conclusion This meta-analysis has demonstrated that differences in the type of fracture and surgical treatment result in outcomes that are distinct from those generated from analysis of all types of fracture and surgical treatments grouped together. This has important implications for clinical decision making and should highlight the need for future trials to adopt more specific inclusion criteria.
Modi HN, Singh H, Athanasiou T, et al., 2016, Random effect modelling of prefrontal cortical haemodynamics to determine the influence of surgical expertise on executive control during temporal stress in the operating room, The Society for Functional Near-Infrared Spectroscopy, Publisher: fNIRS
Bagnall NM, Pucher PH, Johnston MJ, et al., 2016, Informing the process of consent for surgery: identification of key constructs and quality factors, Journal of Surgical Research, Vol: 209, Pages: 86-92, ISSN: 0022-4804
BackgroundInformed consent is a fundamental requirement of any invasive procedure. Failure to obtain appropriate and informed consent may result in unwanted or unnecessary procedures, as well as financial penalty in case of litigation. The aim of this study was to identify key constructs of the consent process which might be used to determine the performance of clinicians taking informed consent in surgery.MethodsA multimodal methodology was used. A systematic review was conducted in accordance with PRISMA guidelines to identify evidence-based components of the consent process. Results were supplemented by semistructured interviews with senior trainees and attending surgeons which were transcribed and subjected to emergent theme analysis with repeated sampling until thematic saturation was reached.ResultsA total of 710 search results were returned, with 26 articles included in the final qualitative synthesis of the systematic review. Significant variation existed between articles in the description of the consent procedure. Sixteen semistructured interviews were conducted before saturation was reached. Key components of the consent process were identified with broad consensus for the most common elements. Trainers felt that experiential learning and targeted skills training courses should be used to improve practice in this area.ConclusionsKey components for obtaining informed consent in surgery have been identified. These should be used to influence curricular design, possible assessment methods, and focus points to improve clinical practice and patient experience in future.
Hull L, Athanasiou T, Russ S, 2016, Implementation Science: A Neglected Opportunity to Accelerate Improvements in the Safety and Quality of Surgical Care., Annals of Surgery, ISSN: 1528-1140
OBJECTIVE: The aim of this review was to emphasize the importance of implementation science in understanding why efforts to integrate evidence-based interventions into surgical practice frequently fail to replicate the improvements reported in early research studies. SUMMARY OF BACKGROUND DATA: Over the past 2 decades, numerous patient safety initiatives have been developed to improve the quality and safety of surgical care. The surgical community is now faced with translating "promising" initiatives from the research environment into clinical practice-the World Health Organization (WHO) has described this task as one of the greatest challenges facing the global health community and has identified the importance of implementation science in scaling up evidence-based interventions. METHODS: Using the WHO surgical safety checklist, a prominent example of a rapidly and widely implemented surgical safety intervention of the past decade, a review of literature, spanning surgery, and implementation science, was conducted to identify and describe a broad range of factors affecting implementation success, including contextual factors, implementation strategies, and implementation outcomes. RESULTS: Our current approach to conceptualizing and measuring the "effectiveness" of interventions has resulted in factors critical to implementing surgical safety interventions successfully being neglected. CONCLUSION: Improvements in the safety and quality of surgical care can be accelerated by drawing more heavily upon implementation science and that until this rapidly evolving field becomes more firmly embedded into surgical research and implementation efforts, our understanding of why interventions such as the checklist "work" in some settings and appear "not to work" in other settings will be limited.
Pirola S, Cheng Z, Jarral OA, et al., 2016, Aortic flow hemodynamics after surgical aortic valve replacement: comparison with a healthy subject, Virtual Physiological Human 2016 Conference
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