1
|
Dovell G, Lyons OT. Mycotic No More: Consensus for Modern Research Practice. Eur J Vasc Endovasc Surg 2024; 67:662. [PMID: 38182113 DOI: 10.1016/j.ejvs.2023.12.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Accepted: 12/29/2023] [Indexed: 01/07/2024]
Affiliation(s)
- George Dovell
- Department of Surgery, University of Otago Christchurch, Christchurch, New Zealand; Health New Zealand Canterbury / Te Whatu Ora Waitaha Canterbury, Christchurch, New Zealand.
| | - Oliver T Lyons
- Department of Surgery, University of Otago Christchurch, Christchurch, New Zealand; Health New Zealand Canterbury / Te Whatu Ora Waitaha Canterbury, Christchurch, New Zealand
| |
Collapse
|
2
|
Thaventhiran A, McKnight G, Clements JM, Barlow E, Pegna V, Dovell G, Nally D, Burke J. The Association of Surgeons in Training (ASiT) Consensus Statement on Major Trauma Training in the UK. Ann R Coll Surg Engl 2024; 106:123-130. [PMID: 36748795 PMCID: PMC10830340 DOI: 10.1308/rcsann.2022.0151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/21/2022] [Indexed: 02/08/2023] Open
Abstract
INTRODUCTION Since the establishment of the Major Trauma Networks in 2012, it is estimated that an extra 1,600 lives have been saved across England. Although the delivery of trauma care has improved significantly, the provision of trauma training has not and remains fragmented. The Association of Surgeons in Training (ASiT), an independent organisation run by trainees, is dedicated to excellence in surgical training within the United Kingdom (UK) and Republic of Ireland (ROI). The aim of this study was to develop a consensus statement representing the views of the ASiT on the future of trauma surgery training. METHODS A modified nominal group technique was used in five stages: 1, scoping exercise; 2, virtual consultation; 3, nominal group consensus meeting; 4, virtual feedback from stakeholders; and 5, virtual confirmation by the ASiT Council. The design and reporting of the consensus followed best practice methodology for consensus research. RESULTS Overall, 62 participants gave 90 statements across stages 1-3. Eleven key themes were identified, all of which met the consensus of the ASiT Council. The key findings were widespread support for increased exposure to trauma for medical students and early surgical trainees as well as an increased use of simulation methods and improved focus on non-technical skills within trauma surgery. CONCLUSIONS This study sets out the position of the ASiT on the future of trauma surgery training and how training in major trauma surgery in the UK and ROI could be improved.
Collapse
Affiliation(s)
| | | | - JM Clements
- The Association of Surgeons in Training, Royal College of Surgeons of England, UK
| | | | | | | | | | | |
Collapse
|
3
|
Gwilym BL, Pallmann P, Waldron CA, Thomas-Jones E, Milosevic S, Brookes-Howell L, Harris D, Massey I, Burton J, Stewart P, Samuel K, Jones S, Cox D, Clothier A, Edwards A, Twine CP, Bosanquet DC, Benson R, Birmpili P, Blair R, Bosanquet DC, Dattani N, Dovell G, Forsythe R, Gwilym BL, Hitchman L, Machin M, Nandhra S, Onida S, Preece R, Saratzis A, Shalhoub J, Singh A, Forget P, Gannon M, Celnik A, Duguid M, Campbell A, Duncan K, Renwick B, Moore J, Maresch M, Kamal D, Kabis M, Hatem M, Juszczak M, Dattani N, Travers H, Shalan A, Elsabbagh M, Rocha-Neves J, Pereira-Neves A, Teixeira J, Lyons O, Lim E, Hamdulay K, Makar R, Zaki S, Francis CT, Azer A, Ghatwary-Tantawy T, Elsayed K, Mittapalli D, Melvin R, Barakat H, Taylor J, Veal S, Hamid HKS, Baili E, Kastrisios G, Maltezos C, Maltezos K, Anastasiadou C, Pachi A, Skotsimara A, Saratzis A, Vijaynagar B, Lau S, Velineni R, Bright E, Montague-Johnstone E, Stewart K, King W, Karkos C, Mitka M, Papadimitriou C, Smith G, Chan E, Shalhoub J, Machin M, Agbeko AE, Amoako J, Vijay A, Roditis K, Papaioannou V, Antoniou A, Tsiantoula P, Bessias N, Papas T, Dovell G, Goodchild F, Nandhra S, Rammell J, Dawkins C, Lapolla P, Sapienza P, Brachini G, Mingoli A, Hussey K, Meldrum A, Dearie L, Nair M, Duncan A, Webb B, Klimach S, Hardy T, Guest F, Hopkins L, Contractor U, Clothier A, McBride O, Hallatt M, Forsythe R, Pang D, Tan LE, Altaf N, Wong J, Thurston B, Ash O, Popplewell M, Grewal A, Jones S, Wardle B, Twine C, Ambler G, Condie N, Lam K, Heigberg-Gibbons F, Saha P, Hayes T, Patel S, Black S, Musajee M, Choudhry A, Hammond E, Costanza M, Shaw P, Feghali A, Chawla A, Surowiec S, Encalada RZ, Benson R, Cadwallader C, Clayton P, Van Herzeele I, Geenens M, Vermeir L, Moreels N, Geers S, Jawien A, Arentewicz T, Kontopodis N, Lioudaki S, Tavlas E, Nyktari V, Oberhuber A, Ibrahim A, Neu J, Nierhoff T, Moulakakis K, Kakkos S, Nikolakopoulos K, Papadoulas S, D'Oria M, Lepidi S, Lowry D, Ooi S, Patterson B, Williams S, Elrefaey GH, Gaba KA, Williams GF, Rodriguez DU, Khashram M, Gormley S, Hart O, Suthers E, French S. Short-term risk prediction after major lower limb amputation: PERCEIVE study. Br J Surg 2022; 109:1300-1311. [PMID: 36065602 DOI: 10.1093/bjs/znac309] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 05/06/2022] [Accepted: 07/31/2022] [Indexed: 01/22/2023]
Abstract
BACKGROUND The accuracy with which healthcare professionals (HCPs) and risk prediction tools predict outcomes after major lower limb amputation (MLLA) is uncertain. The aim of this study was to evaluate the accuracy of predicting short-term (30 days after MLLA) mortality, morbidity, and revisional surgery. METHODS The PERCEIVE (PrEdiction of Risk and Communication of outcomE following major lower limb amputation: a collaboratIVE) study was launched on 1 October 2020. It was an international multicentre study, including adults undergoing MLLA for complications of peripheral arterial disease and/or diabetes. Preoperative predictions of 30-day mortality, morbidity, and MLLA revision by surgeons and anaesthetists were recorded. Probabilities from relevant risk prediction tools were calculated. Evaluation of accuracy included measures of discrimination, calibration, and overall performance. RESULTS Some 537 patients were included. HCPs had acceptable discrimination in predicting mortality (931 predictions; C-statistic 0.758) and MLLA revision (565 predictions; C-statistic 0.756), but were poor at predicting morbidity (980 predictions; C-statistic 0.616). They overpredicted the risk of all outcomes. All except three risk prediction tools had worse discrimination than HCPs for predicting mortality (C-statistics 0.789, 0.774, and 0.773); two of these significantly overestimated the risk compared with HCPs. SORT version 2 (the only tool incorporating HCP predictions) demonstrated better calibration and overall performance (Brier score 0.082) than HCPs. Tools predicting morbidity and MLLA revision had poor discrimination (C-statistics 0.520 and 0.679). CONCLUSION Clinicians predicted mortality and MLLA revision well, but predicted morbidity poorly. They overestimated the risk of mortality, morbidity, and MLLA revision. Most short-term risk prediction tools had poorer discrimination or calibration than HCPs. The best method of predicting mortality was a statistical tool that incorporated HCP estimation.
Collapse
Affiliation(s)
- Brenig L Gwilym
- South East Wales Vascular Network, Aneurin Bevan University Health Board, Royal Gwent Hospital, Newport, UK
| | | | | | | | | | | | - Debbie Harris
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - Ian Massey
- Artificial Limb and Appliance Centre, Rookwood Hospital, Cardiff and Vale University Health Board, Cardiff, UK
| | - Jo Burton
- Artificial Limb and Appliance Centre, Rookwood Hospital, Cardiff and Vale University Health Board, Cardiff, UK
| | - Phillippa Stewart
- Artificial Limb and Appliance Centre, Rookwood Hospital, Cardiff and Vale University Health Board, Cardiff, UK
| | - Katie Samuel
- Department of Anaesthesia, North Bristol NHS Trust, Bristol, UK
| | - Sian Jones
- c/o INVOLVE Health and Care Research Wales, Cardiff, UK
| | - David Cox
- c/o INVOLVE Health and Care Research Wales, Cardiff, UK
| | - Annie Clothier
- South East Wales Vascular Network, Aneurin Bevan University Health Board, Royal Gwent Hospital, Newport, UK
| | - Adrian Edwards
- Division of Population Medicine, Cardiff University, Cardiff, UK
| | - Christopher P Twine
- Bristol, Bath and Weston Vascular Network, North Bristol NHS Trust, Southmead Hospital, Bristol, UK
| | - David C Bosanquet
- South East Wales Vascular Network, Aneurin Bevan University Health Board, Royal Gwent Hospital, Newport, UK
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
4
|
Dovell G, Staniszewska A, Ramirez J, Murray I, Ambler GK, Twine CP, Hinchliffe RJ. A systematic review of outcome reporting for interventions to treat people with diabetic foot ulceration. Diabet Med 2021; 38:e14664. [PMID: 34324741 DOI: 10.1111/dme.14664] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 06/23/2021] [Accepted: 07/27/2021] [Indexed: 12/26/2022]
Abstract
BACKGROUND Diabetic foot ulceration (DFU) is a challenging clinical problem that affects up to a quarter of patients with diabetes in their lifetime. An agreed set of outcomes for assessing treatments or interventions for DFU has not previously been considered. The aim of this study was to identify outcomes that are reported in clinical studies assessing a treatment or intervention for DFU, to inform the development of a core outcome set (COS). METHODS Systematic literature searches were performed between January 2016 and March 2019. The search strategy was pre-registered with PROSPERO (CRD42019128250). Two authors independently screened abstracts for full text review. Outcomes were extracted from selected papers verbatim and categorized into domains according to established taxonomy. Consistency of outcome reporting was assessed. Overlapping outcomes were merged independently to condense the extracted list of outcomes for use in forthcoming consensus processes. RESULTS Of 4645 abstracts identified, 114 studies met the inclusion criteria. There were 69 randomized studies, 40 prospective studies and 5 protocols. Some 948 outcomes were extracted verbatim. Outcome reporting was consistent for 474 (53%) outcomes. De-duplication left 714 unique verbatim outcomes across 33 domains. Merging of overlapping unique verbatim outcomes established 95 merged outcomes. CONCLUSION This study describes contemporary outcomes reported in studies assessing interventions for DFU. Outcome reporting is considered to be poor as it was consistent in just over half of outcomes extracted. Merging of outcomes has identified 95 outcomes that can be taken forward in the development of a COS.
Collapse
Affiliation(s)
- George Dovell
- Centre for Surgical Research, University of Bristol, Bristol, UK
- Department of Vascular Surgery, North Bristol NHS Trust, Bristol, UK
| | | | - Jozel Ramirez
- Centre for Surgical Research, University of Bristol, Bristol, UK
| | - Ines Murray
- Department of Vascular Surgery, North Bristol NHS Trust, Bristol, UK
| | - Graeme K Ambler
- Centre for Surgical Research, University of Bristol, Bristol, UK
- Department of Vascular Surgery, North Bristol NHS Trust, Bristol, UK
| | | | - Robert J Hinchliffe
- Centre for Surgical Research, University of Bristol, Bristol, UK
- Department of Vascular Surgery, North Bristol NHS Trust, Bristol, UK
| |
Collapse
|
5
|
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 D. Systematic Review and Meta-Analysis of Wound Adjuncts for the Prevention of Groin Wound Surgical Site Infection in Arterial Surgery. J Vasc Surg 2021. [DOI: 10.1016/j.jvs.2021.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
6
|
Gwilym BL, Dovell G, Dattani N, Ambler GK, Shalhoub J, Forsythe RO, Benson RA, Nandhra S, Preece R, Onida S, Hitchman L, Coughlin P, Saratzis A, Bosanquet DC. Editor's Choice - Systematic Review and Meta-Analysis of Wound Adjuncts for the Prevention of Groin Wound Surgical Site Infection in Arterial Surgery. Eur J Vasc Endovasc Surg 2021; 61:636-646. [PMID: 33423912 DOI: 10.1016/j.ejvs.2020.11.053] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 11/03/2020] [Accepted: 11/30/2020] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Groin incision surgical site infections (SSIs) following arterial surgery are common and are a source of considerable morbidity. This review evaluates interventions and adjuncts delivered immediately before, during, or after skin closure, to prevent SSIs in patients undergoing arterial interventions involving a groin incision. DATA SOURCES MEDLINE, EMBASE, and CENTRAL databases were searched. REVIEW METHODS This 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. RESULTS The 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. CONCLUSION There 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.
Collapse
Affiliation(s)
- Brenig L Gwilym
- South East Wales Vascular Network, Royal Gwent Hospital, Newport, UK. https://twitter.com/VascResearchNet
| | | | | | | | - Joseph Shalhoub
- Imperial Vascular Unit, Imperial College Healthcare NHS Trust, London, UK; Academic Section of Vascular Surgery, Department of Surgery & Cancer, Imperial College London, London, UK
| | - Rachael O Forsythe
- Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | | | - Sandip Nandhra
- Northern Vascular Centre, Institute of population health sciences, Newcastle University, Newcastle, UK
| | | | - Sarah Onida
- Imperial Vascular Unit, Imperial College Healthcare NHS Trust, London, UK; Academic Section of Vascular Surgery, Department of Surgery & Cancer, Imperial College London, London, UK
| | | | - Patrick Coughlin
- Cardiovascular Interdisciplinary Research Centre, University of Cambridge, Cambridge, UK
| | - Athanasios Saratzis
- NIHR Leicester Biomedical Research Centre, University of Leicester Department of Cardiovascular Sciences, Leicester, UK
| | - David C Bosanquet
- South East Wales Vascular Network, Royal Gwent Hospital, Newport, UK
| |
Collapse
|
7
|
Saratzis A, Bosanquet D, Benson R, Fisher O, Gwilym B, Dattani N, Dovell G, Forsythe R. Current medical management of patients with peripheral arterial disease and potential benefits of risk-factor optimization: A Vascular and Endovascular Research Network (VERN) collaboration. Eur J Vasc Endovasc Surg 2020. [DOI: 10.1016/j.ejvs.2019.12.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
|
8
|
Tham JC, Dovell G, Berrisford RG, Humphreys ML, Wheatley TJ, Sanders G, Ariyarathenam AV. Routine use of feeding jejunostomy in oesophageal cancer resections: results of a survey in England. Dis Esophagus 2020; 33:5585595. [PMID: 31608935 DOI: 10.1093/dote/doz075] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 05/09/2019] [Accepted: 07/26/2019] [Indexed: 12/11/2022]
Abstract
Nutrition and post-operative feeding in oesophageal cancer resections for enhanced recovery remain a controversial subject. Feeding jejunostomy tubes (FJT) have been used post-operatively to address the subject but evidence to support its routine use is contentious. There is currently no data on FJT use in England for oesophageal cancer resections. Knowledge regarding current FJT usage, and rationale for its use may provide a snapshot of the trend and current standing on FJT use by resectional units in England. A standardised survey was sent electronically to all oesophageal resectional units in the United Kingdom (UK) between October 2016 and January 2018. In summary, the questionnaire probes into current FJT use, rationale for its usage, consideration of cessation of its use, and rationale of cessation of its use for units not using FJT. The resectional units were identified using the National Oesophago-Gastric Cancer Audit (NOGCA) progress report 2016 and 1 selected resectional unit from Northern Ireland, Scotland, and Wales, respectively. Performance data of those units were collected from the 2017 NOGCA report. Out of 40 units that were eligible, 32 (80.0%) centres responded. The responses show a heterogeneity of FJT use across the resectional centres. Most centres (56.3%) still place FJT routinely with 2 of 18 (11.1%) were considering stopping its routine use. FJT was considered a mandatory adjunct to chemotherapy in 3 (9.4%) centres. FJT was not routinely used in 9 (28.1%) of centres with 5 of 9 (55.6%) reported previous complications and 4 of 9 (44.4%) cited using other forms of nutrition supplementation as factors for discontinuing FJT use. There were 5 (15.6%) centres with divided practice among its consultants. Of those 2 of 5 (40.0%) were considering stopping FJT use, and hence, a total of 4 of 23 (17.4%) of units are now considering stopping routine FJT use. In conclusion, the wider practice of FJT use in the UK remains heterogenous. More research regarding the optimal post-operative feeding regimen needs to be undertaken.
Collapse
Affiliation(s)
- J C Tham
- Peninsula Oesophago-Gastric Centre, University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - G Dovell
- Peninsula Oesophago-Gastric Centre, University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - R G Berrisford
- Peninsula Oesophago-Gastric Centre, University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - M L Humphreys
- Peninsula Oesophago-Gastric Centre, University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - T J Wheatley
- Peninsula Oesophago-Gastric Centre, University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - G Sanders
- Peninsula Oesophago-Gastric Centre, University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - A V Ariyarathenam
- Peninsula Oesophago-Gastric Centre, University Hospitals Plymouth NHS Trust, Plymouth, UK
| |
Collapse
|
9
|
Dovell G, Rogers CA, Armstrong R, Harris RA, Hinchliffe RJ, Mouton R. The Effect of Mode of Anaesthesia on Outcomes After Elective Endovascular Repair of Abdominal Aortic Aneurysm. Eur J Vasc Endovasc Surg 2020; 59:729-738. [PMID: 32291124 DOI: 10.1016/j.ejvs.2020.01.031] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Revised: 01/06/2020] [Accepted: 01/20/2020] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Endovascular aneurysm repair (EVAR) is the most commonly used method to repair abdominal aortic aneurysms. EVAR can be performed using a variety of anaesthetic techniques, including general anaesthetic (GA), regional anaesthetic (RA), and local anaesthetic (LA), but little is known about the effects that each of these anaesthetic modes have on patient outcome. The aim of this study was to assess the effect of anaesthetic technique on early outcomes after elective EVAR. METHODS Data from the UK's National Vascular Registry were analysed. All patients undergoing elective standard infrarenal EVAR between 1 January 2014 and 31 December 2016 were included. Patients with a symptomatic aneurysm treated semi-electively were excluded. The primary outcome was in hospital death within 30 days of surgery. Secondary outcomes included post-operative complications and length of hospital stay. Time to event outcomes were compared using Cox proportional hazards regression adjusted for confounders, including British Aneurysm Repair score (a validated aneurysm risk prediction score that is calculated using age, sex, creatinine, cardiac disease, electrocardiogram, previous aortic surgery, white blood cell count, serum sodium, abdominal aortic aneurysm diameter, and American Society of Anaesthesiologists grade) and chronic lung disease. RESULTS A total of 9783 patients received an elective, standard infrarenal EVAR (GA, n = 7069; RA, n = 2347; and LA, n = 367) across 89 hospitals. RA and/or LA was used in 82 hospitals. There were 64 in hospital deaths within 30 days, 50 (0.9% mortality at 30 days, 95% confidence interval [CI] 0.7-1.2) in the GA group, 11 (0.6%, 95% CI 0.3-1.1) in the RA group, and three (1.5%, 95% CI 0.5-4.7) in the LA group. The mortality rate differed between groups (p = .03) and was significantly lower in the RA group compared with the GA group (adjusted hazard ratio [aHR] RA/GA 0.37 [95% CI 0.17-0.81]; LA/GA 0.63 [95% CI 0.15-2.69]). The median length of stay was two days for all modes of anaesthesia, but patients were discharged from hospital more quickly in the RA and LA groups than the GA group (aHR RA/GA 1.10 [95% CI 1.03-1.17]; LA/GA 1.15 [95% CI 1.02-1.29]). Overall, 20.7% of patients experienced one or more complications (GA group, 22.1%; RA group, 16.8%; LA group, 17.7%) and pulmonary complications occurred with similar frequency in the three groups (overall 2.4%, adjusted odds ratio RA/GA 0.93 [95% CI 0.66-1.32]; LA/GA 0.82 [95% CI 0.41-1.63]). CONCLUSION Thirty day mortality was lower with RA than with GA, but mode of anaesthesia was not associated with increased complications for patients undergoing elective standard infrarenal EVAR.
Collapse
Affiliation(s)
- George Dovell
- Bristol Centre for Surgical Research, University of Bristol, Bristol, UK; Department of Vascular Surgery, Southmead Hospital, Bristol, UK.
| | - Chris A Rogers
- Clinical Trials and Evaluation Unit, Bristol Trials Centre, Bristol Medical School, University of Bristol, Bristol, UK
| | | | - Rosie A Harris
- Clinical Trials and Evaluation Unit, Bristol Trials Centre, Bristol Medical School, University of Bristol, Bristol, UK
| | - Robert J Hinchliffe
- Bristol Centre for Surgical Research, University of Bristol, Bristol, UK; Department of Vascular Surgery, Southmead Hospital, Bristol, UK
| | - Ronelle Mouton
- Department of Anaesthesia, Southmead Hospital, Bristol, UK
| |
Collapse
|
10
|
Gwilym BL, Saratzis A, Benson R, Forsythe R, Dovell G, Dattani N, Lane T, Preece R, Shalhoub J, Bosanquet DC. Study protocol for the groin wound infection after vascular exposure (GIVE) audit and multicentre cohort study. Int J Surg Protoc 2019; 16:9-13. [PMID: 31897443 PMCID: PMC6921153 DOI: 10.1016/j.isjp.2019.06.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 05/27/2019] [Accepted: 06/02/2019] [Indexed: 01/05/2023] Open
Abstract
INTRODUCTION Surgical site infections (SSIs) following groin incision for arterial exposure are commonplace and a significant cause of morbidity and mortality following major arterial surgery. Published incidence varies considerably. The primary aim of GIVE will be to compare individual units' practice with established guidelines from The National Institute for Health and Care Excellence (NICE). Secondary aims will be to describe the contemporary rate of SSI in patients undergoing groin incision for arterial exposure, to identify risk factors for groin wound infection, to examine the value of published tools in the prediction of SSI, to identify areas of equipoise which could be examined in future efficacy/effectiveness trials and to compare UK SSI rates with international centres. METHODS AND ANALYSIS This international, multicentre, prospective observational study will be delivered via the Vascular and Endovascular Research Network (VERN). Participating centres will identify all patients undergoing clean emergency or elective groin incision(s) for arterial intervention during a consecutive 3-month period. Follow up data will be captured at 90 days after surgery. SSIs will be defined according to the Centres for Disease Control and Prevention (CDC) criteria. Data will be gathered centrally using an anonymised electronic data collection tool or secure email transfer. ETHICS AND DISSEMINATION This study will be registered as a clinical audit at all participating UK centres; research ethics approval is not required. National leads will oversee the appropriate registration and approvals in countries outside the UK as required. Site specific reports of SSI rates will be provided to each participating centre. Study results will be disseminated locally at each site, publicised on social media and submitted for peer-reviewed publication.
Collapse
Affiliation(s)
- Brenig Llwyd Gwilym
- Gwent Vascular Institute, Royal Gwent Hospital, Aneurin Bevan University Health Board, Newport, UK
| | - Athanasios Saratzis
- NIHR Leicester Biomedical Research Centre (BRC), Leicester, UK
- Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - Ruth Benson
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
- Department of Vascular Surgery, Dudley Group NHS Foundation Trust, Dudley, UK
| | - Rachael Forsythe
- British Heart Foundation/University of Edinburgh Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
- Department of Vascular Surgery, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - George Dovell
- Bristol Centre for Surgical Research, University of Bristol, Bristol, UK
- Department of Vascular Surgery, North Bristol NHS Trust, Bristol, UK
| | - Nikesh Dattani
- Department of Vascular Surgery, Russels Hall Hospital, Dudley Group NHS Foundation Trust, Dudley, UK
| | - Tristan Lane
- Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Ryan Preece
- Department of Vascular Surgery, Imperial College Healthcare NHS Trust, London, UK
| | - Joseph Shalhoub
- Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, London, UK
- Department of Vascular Surgery, Imperial College Healthcare NHS Trust, London, UK
| | - David Charles Bosanquet
- Gwent Vascular Institute, Royal Gwent Hospital, Aneurin Bevan University Health Board, Newport, UK
- Department of Vascular Surgery, North Bristol NHS Trust, Bristol, UK
| |
Collapse
|
11
|
Saratzis A, Jaspers NEM, Gwilym B, Thomas O, Tsui A, Lefroy R, Parks M, Htun V, Mera Z, Thatcher A, Bosanquet D, Forsythe R, Benson R, Dattani N, Dovell G, Lane T, Shalhoub J, Sidloff D, Visseren FLJ, Dorresteijn JAN, Richards T. Observational study of the medical management of patients with peripheral artery disease. Br J Surg 2019; 106:1168-1177. [PMID: 31259387 DOI: 10.1002/bjs.11214] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Revised: 02/21/2019] [Accepted: 03/23/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND Previous research has suggested that patients with peripheral artery disease (PAD) are not offered adequate risk factor modification, despite their high cardiovascular risk. The aim of this study was to assess the cardiovascular profiles of patients with PAD and quantify the survival benefits of target-based risk factor modification. METHODS The Vascular and Endovascular Research Network (VERN) prospectively collected cardiovascular profiles of patients with PAD from ten UK vascular centres (April to June 2018) to assess practice against UK and European goal-directed best medical therapy guidelines. Risk and benefits of risk factor control were estimated using the SMART-REACH model, a validated cardiovascular prediction tool for patients with PAD. RESULTS Some 440 patients (mean(s.d.) age 70(11) years, 24·8 per cent women) were included in the study. Mean(s.d.) cholesterol (4·3(1·2) mmol/l) and LDL-cholesterol (2·7(1·1) mmol/l) levels were above recommended targets; 319 patients (72·5 per cent) were hypertensive and 343 (78·0 per cent) were active smokers. Only 11·1 per cent of patients were prescribed high-dose statin therapy and 39·1 per cent an antithrombotic agent. The median calculated risk of a major cardiovascular event over 10 years was 53 (i.q.r. 44-62) per cent. Controlling all modifiable cardiovascular risk factors based on UK and European guidance targets (LDL-cholesterol less than 2 mmol/l, systolic BP under 140 mmHg, smoking cessation, antiplatelet therapy) would lead to an absolute risk reduction of the median 10-year cardiovascular risk by 29 (20-38) per cent with 6·3 (4·0-9·3) cardiovascular disease-free years gained. CONCLUSION The medical management of patients with PAD in this secondary care cohort was suboptimal. Controlling modifiable risk factors to guideline-based targets would confer significant patient benefit.
Collapse
Affiliation(s)
- A Saratzis
- National Institute for Health Research Leicester Biomedical Research Centre, Leicester, UK
| | - N E M Jaspers
- Department of Vascular Medicine, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - B Gwilym
- Vascular and Endovascular Research Network, Birmingham, UK
| | - O Thomas
- Vascular and Endovascular Research Network, Birmingham, UK
| | - A Tsui
- Vascular and Endovascular Research Network, Birmingham, UK
| | - R Lefroy
- Vascular and Endovascular Research Network, Birmingham, UK
| | - M Parks
- Vascular and Endovascular Research Network, Birmingham, UK
| | - V Htun
- Vascular and Endovascular Research Network, Birmingham, UK
| | - Z Mera
- Vascular and Endovascular Research Network, Birmingham, UK
| | - A Thatcher
- Vascular and Endovascular Research Network, Birmingham, UK
| | - D Bosanquet
- Vascular and Endovascular Research Network, Birmingham, UK
| | - R Forsythe
- Vascular and Endovascular Research Network, Birmingham, UK
| | - R Benson
- Vascular and Endovascular Research Network, Birmingham, UK
| | - N Dattani
- Vascular and Endovascular Research Network, Birmingham, UK
| | - G Dovell
- Vascular and Endovascular Research Network, Birmingham, UK
| | - T Lane
- Vascular and Endovascular Research Network, Birmingham, UK
| | - J Shalhoub
- Vascular and Endovascular Research Network, Birmingham, UK
| | - D Sidloff
- Vascular and Endovascular Research Network, Birmingham, UK
| | - F L J Visseren
- Department of Vascular Medicine, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - J A N Dorresteijn
- Department of Vascular Medicine, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - T Richards
- Department of Vascular Surgery, University of Western Australia, Perth, Western Australia, Australia
| | | |
Collapse
|
12
|
Mouton R, Dovell G, Rogers C, Harris R, Hinchliffe R. Anaesthesia Technique and Outcomes Following Endovascular Aneurysm Repair of Ruptured Abdominal Aortic Aneurysm. Eur J Vasc Endovasc Surg 2018. [DOI: 10.1016/j.ejvs.2018.08.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
13
|
Platt E, Dovell G, Smolarek S. Systematic review of outcomes following pelvic exenteration for the treatment of primary and recurrent locally advanced rectal cancer. Tech Coloproctol 2018; 22:835-845. [PMID: 30506497 DOI: 10.1007/s10151-018-1883-1] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2018] [Accepted: 11/13/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Pelvic exenteration represents the best treatment option for cure of locally advanced or recurrent rectal cancer. This systematic review sought to evaluate current literature regarding short and long term treatment outcomes and long term survival following pelvic exenteration. METHODS A systematic search of the MEDLINE, PubMed and Ovid databases was conducted to identify suitable articles published between 2001 and 2016. The article search was performed in line with Cochrane methodology and reported according to the Preferred Reporting Items for Systematic reviews and Meta-analyses statement. RESULTS Sixteen studies were included in the final analysis, incorporating 1016 patients. Sixty-three percent of patients were male and median patient age was 59 years. Median operating time was 7.2 h with median blood loss of 1.9 l. Median postoperative stay was 17 days with a median 30-day mortality of 0. Complication rates were 31.6-86% with a return to theatre rate of 14.6%. Median R0 resection rate was 74% and was higher for primary cancer (82.6% versus 58% for recurrent cancer). Mean overall survival was 31 months and median 5-year survival was 32%. Recurrently identified indicators of adverse outcome included R1/2 resection, preoperative pelvic pain and previous abdominoperineal resection of the rectum. CONCLUSIONS Pelvic exenteration remains a major operation associated with significant morbidity and mortality. Despite advances in preoperative assessment and staging, R1 resection rates remain high. There is also a high degree of variability of reporting outcomes and standardisation of this process would aid comparison of results between centres and drive forward research in this area.
Collapse
Affiliation(s)
- E Platt
- Colorectal Unit, Derriford Hospital, Plymouth Hospital NHS Trust, Plymouth, UK.
| | - G Dovell
- Colorectal Unit, Derriford Hospital, Plymouth Hospital NHS Trust, Plymouth, UK
| | - S Smolarek
- Colorectal Unit, Derriford Hospital, Plymouth Hospital NHS Trust, Plymouth, UK
| |
Collapse
|
14
|
Morley R, Edmondson M, Dovell G, Blencowe N, Main B, Blazeby J, Hinchliffe R. #16 The introduction and evolution of an innovative endovascular device for venous arterialisation: A systematic analysis of current practice (poster presentation). Int J Surg 2018. [DOI: 10.1016/j.ijsu.2018.10.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
15
|
Hardy T, Dovell G. Shunt insertion in carotid endarterectomy - Can we simulate it and does it work? Int J Surg 2018. [DOI: 10.1016/j.ijsu.2018.05.466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
|
16
|
Hardy T, Dovell G, Hindle M, Bateman K, Desmond A. Physician Associates – Junior Doctors’ Perceptions Ahead of Deployment. Int J Surg 2017. [DOI: 10.1016/j.ijsu.2017.08.356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
17
|
Dovell G, Tham J, Sanders G. Access to Ultrasound for Acute Surgical Patients: Assessing the Weekend Effect. Int J Surg 2017. [DOI: 10.1016/j.ijsu.2017.08.190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
18
|
Dovell G, Hinchliffe RJ. Surgery for popliteal artery entrapment syndrome: use of an intraoperative tibial nerve stimulator and duplex ultrasound. Ann R Coll Surg Engl 2017; 100:78-79. [PMID: 29022807 DOI: 10.1308/rcsann.2017.0099] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- G Dovell
- Bristol Centre for Surgical Research, School of Social and Community Medicine , Bristol , UK
| | - R J Hinchliffe
- Bristol Centre for Surgical Research, School of Social and Community Medicine , Bristol , UK
| |
Collapse
|