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Surgical Research Funds, University of Newcastle, Australia.

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Number	Citation Analysis
1	Xu W, Liu G, Varghese C, Wells C, Smith N, Windsor J, Gaborit L, Goh S, Basam A, Elhadi M, Soh RT, Saeed U, Abdulwahed E, Farrell M, Wright D, Martin J, Pockney P, Xu W, Basam A, Goh S, Li J, Shah J, Waraich A, Gaborit L, Pathak U, Hilder A, Elhadi M, Jabur A, Kalyanasundaram K, Ohis C, Ong CF, Park M, Siribaddana V, Raubenheimer K, Vu J, Wells C, Liu G, Ferguson L, Xu W, Varghese C, Pockney P, Atherton K, Dawson A, Martin J, Banerjee A, Dudi-Venkata N, Lightfoot N, Ludbrook I, Peters L, Sara R, Watson D, Wright D, Adeyeye A, Alvarez-Lozada LA, Atici SD, Buhavac M, Calini G, Elhadi M, Ioannidis O, Tepe MD, Nath U, Uzair A, Yang W, Zaidi F, Singh S, Abdullah B, Palacios DSG, Ragab A, Ahmed A, Raubenheimer K, Daudu D, Goh S, Benyani SV, Karthikeyan N, Mansour LT, Seow W, Tasi Z, Jabur A, Pathak U, Park M, Abdelmelek DE, Boussahel IFZ, Kaabache O, Lemdaoui N, Nebbar O, Rais M, Abdoun M, Kouicem AT, Bouaoud S, Bouchenak K, Saada H, Ouyahia A, Messai W, Choong ZS, Ting C, Larkin M, Fong PJ, Soh I, Grandi AD, Iftikhar H, Sinha A, Kapoor D, Chlebicka T, Singer D, Goddard K, Matthews L, Lin R, Chambers J, Chan J, Macnab B, Barker J, Mckenzie M, Ferguson N, Juwaheer G, Muralidharan V, Gill S, Sung N, Patel R, Walters C, Nguyen K, Liu D, Cabalag C, Lee J, Leow SHA, Ng SL, Ashraf H, Mulder F, Loo J, Proud D, Wong S, Zhou Y, Soh QR, Chye D, Stevens S, Tang P, Kritharides S, Dong J, Morice O, Huang D, Hardidge A, Amarasekara M, Kink A, Bolton D, Rawal A, Singh J, Heard M, Hassan Y, Naqeeb A, Cobden A, Prinsloo D, Quadros D, Gunn E, Kim HJ, Ekwebelam J, Shanahan J, Alkazali M, Hoosenally M, Nara N, Nguyen P, Barker S, Hilder A, Hui A, Karmakar A, Wang B, Goonawardena J, Cheung KT, Chan N, Natarajan R, Cade R, Jin R, Sengupta S, Snider R, Morisetty H, Weeda L, Sun P, Chilaka L, Cover J, Gunasekara ADSA, Senthilrajan R, Alwahaib A, Limmer A, Zamanbandhon B, Jaffry K, Shen Y, Chua A, Syed S, Saha S, Glynatsis J, Aitchison L, Lagana B, Crossman M, Watson D, Dawson A, Fong B, Harrison E, Horsburgh E, Glynatsis J, Khoo M, Mishra K, Hewton L, Mesecke A, Tu H, Tun T, Wong J, Ong E, Law TN, Landy A, Leano A, Li A, Soni A, Dowdle B, Pilgrim C, Abeysirigunawardana D, Jeyarajan DR, Patel D, Mckinnon K, Gould M, Gilmore P, Geng R, Loughnan R, Norton-Smith S, Nyame S, Tan S, Yoon SW, Wang Y, Zhang Y, Wang Z, Mare H, Withanage I, Khattar M, Toft A, Sivasuthan G, Zhao H, Addley J, O'brien L, Raza M, Bindra R, Sharma S, Cornwell C, Patil A, Cheung A, Lown A, Dawson A, Blassey A, Ochigbo B, Cheng F, Fatima A, Zhang E, Kocatekin H, Roth C, Brewster D, Kwok K, Chen P, Laura S, Tynan D, Latif E, Lun E, Honore E, Ziergiebel F, Blake J, Chandiok K, Bird K, Ngothanh L, Lee M, El-Masry M, Hamer P, Palaniappan RR, Mcgee R, Huang S, Zhang S, Hariharan S, Silva YD, Lee C, Fotheringham P, Incoll I, Cordingley T, Cheng F, Brown M, Kang L, Wijayaratne R, Moore P, Qian G, Elgindy Y, Carnuccio E, Rae H, Shehata M, Liu M, Lockwood B, Bockxmeer JV, Alsoudani A, Swan D, Hsieh J, Orchard-Hall F, Tay KYJ, Mehra R, Gebeh A, Bailey A, Brown G, Colaco A, Gopal H, Boyley J, Changati V, Fletcher J, Khandelwal T, House C, O'neil C, Jaarsma E, Ly V, Balogh Z, Shui A, Sathasivam V, Legge-Wilkinson H, Wong KH, Chen A, Tran A, Rehfisch P, Wang G, Nguyen J, Peker J, Gallert K, Komesaroff M, Namburi M, Goldfinch E, Muchabaiwa R, Jangam A, Taylor I, Nusem I, Park JH(D, Gundara J, Heigan R, Tran T, Mackay T, Butterworth Y, Sadauskas T, Tung M, Ellepola H, Gan C, Fong H, Das A, Naicker L, Hauptman S, Kamath A, Yew A, Parange A, Kim K, Kharwadkar S, Gamage T, Vance L, Seldon A, Ghaly M, Phan V, Chauhan K, Bassam A, Vollenhoven B, Jaffry K, Mandhan K, Sritharan M, Sakthivel M, Evans N, Robinson S, Sivakumar S, Marrison L, Jollow D, Joshi K, Tao S, Shrestha P, Nukala SK, Hodgson R, Crotty A, Esho A, Harris A, Surkitt A, Bland L, Mcleod B, Yin C, Keng C, Greenwood E, Yuan G, Haege E, Wu H, Xiao H, Pozzi I, Fu J, Ross JS, Gentle J, Gan K, Chang K, Sun K, Singh M, Xie M, Mccabe N, Slavec M, Clarnette N, Niknami B, Zou P, Flintoft S, Jayatilleke S, Sok R, Tan S, Wadhwa S, Swansson W, Abulafia D, Blundell J, Sweetapple A, Solar CD, Martin C, Bell D, Fernando I, Chang J, Vanzuylekom K, Zuylekom KV, Zuylekom KV, Hobbs K, Liang R, Jabur A, Tarmidi J, Ugool M, Beatson N, Bowman S, Moin S, Tan WPJ, Chidambaram S, Gan SW, Wang P, Naicker L, Kim K, Wang NQ, Kwan YX, Patil C, Joshi D, Kamath A, Hanan A, Sheriff A, Duffield J, Naiker L, Smitham P, Neo EL, Chua M, Prasad S, Nagaratnam A, Sammour T, Lin Y, Lee C, Hopping E, Jangra M, Das A, Lin K, Bunjo Z, Raubenheimer K, Yunos MHM, Yeung KL, Phu R, Betts A, Just B, Gera S, Leeson H, Jamieson J, Wang K, Luu E, Innes M, Vu J, Hong J, Dzator S, Flame A, Jiang V, Kwok J, Lawrence A, Meads K, Pearce L, Sarangadasa P, Shaw H, Yu V, Crostella ;E, Wong J, Bobba S, Muller M, Hau YCH, Wilson T, Markovic A, Green J, Forbes C, Burrows E, Hou L, O'sullivan C, Foo J, Greig H, Collins AJ, Chandler C, Heaney E, Gross H, Morgan M, Loder R, Rajesh K, Ananthapadmanabhan S, Razmi A, Vong C, Pothukuchi P, Theophilus M, Sriranjan R, Kaur S, Kanczuk M, Groot JD, Corrigan A, Li D, Badri D, Ciranni D, Needi ET, Clanfield M, Copertino N, Rumble W, Vanguardia MK, Lew C, Dennaoui R, Shah J, Kong J, Koh I, Zeng R, Baziotis-Kalfas K, Denby H, Li A, Tran W, Singh A, Lin O, Chau M, Donaldson O, Min C(S, Ballah S, Tsui SCT, Yong N, Standish L, Tan S, Fujihara A, Davies L, Odisho R, Ravi A, Collins J, Chandra P, Abdelmeguid R, Singh G, Feierdaiweisi X, Seneviratne D, Srivastava S, Yao M, Teng C, Chowdhury N, Vidanagama S, Lin C, Sampatha-Waduge T, Wang E, Yodkitydomying C, Koh I, Silverii J, Lam A, Zeng R, Solanki K, Franks A, Edwards L, Atilhan R, Nandurkar R, Wells O, Vanguardia K, King D, Edwards E, Edwards L, Tran Q, Chau M, Min S, Rauf A, Fu Y, Haximolla H, Shang M, Segaran S, Wang S, Sivakumar G, Sandhu JK, Mishra N, Hauptman S, Chua A, Chene D, Maddern G, Shaw H, Wang Q, Pang S, Lu C, Fung J, Cyr K, Lu K, How MZ, Hu N, Anderson P, Jakanovski P, Youssef A, Tang H, Keenan R, Chan A, Canny M, Tahir F, Egerton J, Yeung J, Chan J, Tiffany L, Bei M, Raj M, Williams P, Nagpal S, Outhred T, Krawitz R, Choi CCM, Younus K, Giurgius M, Kirk R, Pegorer AG, Tang-Ieam P, Ward J, Wijetunga A, Zhang C, Nahm C, Wang C, Golja D, Jenkins G, Qian H, Luong J, Nguyen K, Suttor S, Lai S, Ma V, Chen Y, Yu HH, Lee A, Barbaro A, Mcguinness C, Maddern G, Young S, Lim YF, Trotta G, Chao P, Ding G, Fang C, Lu A, Wagaarachchi P, Cornwell C, Gojnich A, Stewart P, Dong I, Wong K, Burruso L, Hogan L, Mcorist N, Singh R, Jeyamohan R, Hou Z, Lai W, Taylor E, Palacios DSG, Pantoja MAN, Nanez DMB, Hernandez GOP, Jimenez Ramirez LJ, Mohamed M, El-Taher AK, Elewa A, Soliman MA, Diab M, Ali R, Ahmed A, Galal A, Elkhodary A, Alaa A, Faisal A, Badawy A, Eldomiaty D, Sayed MA, Rasslan E, Ramadan M, Fares GE, Altabbaa H, Emad H, Alboridy M, Mongy M, Albarhomy O, Selim O, Rafaei R, Atta R, Altaweel A, Sherif Y, Elghoul Y, Tarek Y, Sabry AA, Moustafa A, AbouHiekal O, Shaqran OA, Haggag Z, Abbas AM, Temerik AR, Atef D, Mahmoud A, Saad MM, Ragab M, Mahmoud AO, Hussien A, Abdelbaky M, Muhammad I, Morad A, Ali A, Hussien A, Shipa A, Aboulfotouh A, Abdelaal AM, Hashem AM, Youssef AA, Morsi A, Ebrahim A, Sayed AM, Kamel AM, Elmaghrabey A, Elgharib AM, Abdelrahman A, Ali A, Abdelnaeam S, Emam A, el-mola AG, Shaban A, Shaltout AS, Nabil B, Barsoum F, Mostafa E, Abdelbaset D, Salah D, Othman D, Othman S, Khairallah NS, Hassan SA, Morsi S, Azer A, Abdelsamed EA, Ahmed R, Ibrahim I, AbdElbaset E, Hamoda E, Monib F, Harb F, Maher H, Ahmed H, Mohammed H, Hana K, Ayoub K, Henes K, Shamshoon K, Soliman K, Hassanein M, Abdelhamid MM, Mahdy M, Khalil M, Ali M, Khalifa M, Amary M, Suliman ME, Abdallah MM, Nasr MSA, Elia M, Adly M, Roshdy M, Ramadan MF, Shahat MA, Abdelnasser MK, Zaed M, Al-Quossi M, Zarzour MA, Hares MM, Abdelfatah MA, Abughanima M, Abdeljaber M, Saber M, Amin MK, Abbas M, Haroon O, Khalil O, Talaat O, Elnagar R, Soliman R, Aboelela R, Salah S, Abdelgawad S, Mohammed T, Hussien TA, Sobhy G, Sayed Y, Silem YOR, Dawood A, Hemaida T, Ahmed R, Kamaleldin A, Zakaria A, Salah M, Salem E, Rashed OFAA, Halawa M, Elfeki H, Mosaad A, Shaaban A, Abdelsalam H, Sakr A, Sanad A, Elsawy A, Maged BM, Hegazy D, Abdelmaksoud M, Laymon M, Taman M, Moawad ER, AboElfarh HE, Elkenawi K, Osama M, Sadek M, Elghazy MA, Attia M, Nader M, Shalaby M, Attiya O, Gaarour OS, Zaghloul A, Mikhail P, Badr K, Soltan H, Donia M, Gaafar M, Abdelwahab K, Sallam A, Eid A, Yousri M, Hamdy O, Al-Touny A, Alshawadfy A, Hamdy A, Ellilly A, Mahdy A, El-Sakka A, Hendawy H, Salah A, Raslan B, Teema E, Albayadi E, Nasser E, Mohamed H, Mahmoud M, Elsaied M, Taha O, Dahshan S, Al-Touny S, Karrar A, Khairy A, Farag A, Deafallah A, Ads AM, Alomar R, AbuShawareb I, Saeed A, Mashaal A, Ads AM, Ghanem S, Elghamry A, Nada EA, Noureldin YA, Fouda MF, Shaheen N, Allam S, Mazrou I, Shehab AF, Kussaili W, Korkolis D, Fradelos E, Sarafi A, Machairas N, Giannakopoulos KS, Stavratis F, Korovesis G, Tsourouflis G, Keramida MD, Kydonakis N, Kykalos S, Syllaios A, Dorovinis P, Schizas D, Ioannidis O, Malliora A, Anestiadou E, Zapsalis K, Kontidis F, Loutzidou L, Ouzounidis N, Bitsianis S, Symeonidis S, Skalidou S, Ioannidis O, Valaroutsou OM, Dagklis T, Arvanitaki A, Mamopoulos A, Athanasiadis A, Kopatsaris S, Kalogiannidis I, Tsakiridis I, Kapetanios G, Papanikolaou E, Tsakiridis N, Zachomitros F, Larentzakis A, Gyftopoulos A, Albanopoulos K, Champipis A, Yiannakopoulos C, Vrakopoulou GZ, Saliaris K, Lathouras K, Skoufias S, Doulami G, Bareka M, Arnaoutoglou E, Angelis F, Angeslis F, Hantes M, Ntalouka M, Al-Juaifari MA, Alwash M, Maala R, Zwain YA, Saleh SA, Khorsheed M, Pesce A, Feo CV, Bernabei M, Petrarulo F, Fabbri N, Labriola R, Barbara SJ, Bosi S, Romano A, Canavese A, Catalioto C, Isopi C, Larotonda C, Dajti G, Rottoli M, Russo IS, Cardelli S, Castagnini F, Traina F, Guizzardi G, Giuzzardi G, Gorgone M, Maestri M, Cianci P, Conversano I, Restini E, Gattulli D, Grillea G, Varesano M, Calini G, Andriani A, Gattesco D, Terrosu G, Zambon M, Cerinic PM, Moretti L, Muschitiello D, Polo S, Bresadola V, Wardeh SA, Al-Baw M, Alhaleeq S, Al-Issawi S, Alsaify E, Banihani F, Massadeh N, Massadeh N, Al-issawi D, Elyan B, Al-Shami Q, Alomari Y, Khamees A, Al-Tahayneh SA, Alsheik A, Sawaftah K, Sarhan O, Alkhatib AA, Alzghoul B, Saleh A, Yaghmour J, Shahin M, Maali M, Alatefi D, Al-Smirat H, Hezam A, Alathameen N, Kaddah AA, Al Hammoud A, Ayasrah S, Abuuqteish H, Al-Mwajeh T, Makableh R, Bataineh S, Shabaneh A, Alnatsheh W, Aldeges M, Hamad H, Shehahda S, Khassawneh D, Alzyoud O, Alrosan R, Awad H, Khaldoon T, Shannaq R, hamoud MA, fadalah BA, Al-Hazaimeh M, Khraise W, Alnajjar L, Alnajjar M, Al-Omary S, Ababneh A, Albashaireh A, Khadrawi M, Aljamal M, Athamneh T, Muqbel RA, Al-jammal M, Masarrat A, Al-zawaydeh A, Taha I, Qattawi T, Smadi R, Alhaleem A, Alboon M, Hazaymeh O, Karasneh L, Al-Haek S, Almahroush M, Alfrijat T, Elporgay A, Shanag H, Agilla H, Alameen H, Bensalem M, Altair M, Ghemmied M, Alarabi R, Alhudhairy S, Gweder R, Alzarroug A, Alabed E, Elreaid F, Elkharaz OA, Elreaid FF, Albatni SS, Elmehdawi H, Gahwagi M, Mohamed A, Alfrjani T, Khafifi K, Rasheed A, Akwaisah A, Bushaala H, Elfadli M, Moftah M, Algabbasi S, Esaiti S, Elfallah S, Alharam A, Alariby F, Isweesi M, Eldarat TA, Dabas AA, Alkaseek A, Abodina AM, Alqaarh A, Bakeer HB, Alhaddad HS, Aboudlal H, Alsaih S, Abubaker N, Abdelrahim N, Alzarga A, Omar B, Faris F, Alhadad Q, Abufanas A, Badi H, Benismai I, Obeid H, Abdalei A, Abdulrahman A, Swalem A, Alzarouq E, Safar A, Shagroun E, Hashem B, Elrishi F, Abdulali F, Ahmed H, Eltaib I, Elzoubia J, Albarki A, Mugassabi HE, Abushaala F, Abuzaho A, Juha N, Egzait R, Shetwan S, Lemhaishi A, Matoug F, Abdulwahed E, Askar A, Ashur AB, Bezweek A, Altughar B, Emhimmed D, Elferis D, Elgherwi L, Soula E, Gidiem D, Grada M, Derwish K, Alameen M, Algatanesh N, Elkheshebi A, Ghmagh R, Barka S, Ahmeed S, Aljamal S, Alragig Z, Addalla M, Atia A, Kharim A, Mahmoud F, Binnawara M, Alshareea E, Alsori M, Alshawesh A, Alrifae GMH, Ashour A, Abozid A, Alflite AOS, Mohamed A, Arebi J, Alagelli F, Gineeb HY, Ghmagh R, Omar RMB, Alaqoubi R, Mohammed S, Bensalem SH, Elgadi T, Sami W, Bariun Y, Alhashimi AMA, Abdulla DA, Rhuma H, Enaami H, Alboueishi AA, Alkchr HBHMAA, Albakosh BA, Hasan NB, Alsari N, Aldreawi M, Abushanab K, Yahya R, Samalavicius N, Eismontas V, Jurgaitis J, Aliosin O, Nutautiene V, Zakaria AD, Pillai AKSK, Vadioaloo DK, Daud MAM, Soh JY, Zakaria MZ, Rusli SM, Ashar NAK, Ahmad ZA, Ramlee AA, Alsagoff SNASAL, Sofian AA, Jamil MBHM, Abdullah B, Noorman MF, Abidin MFZ, Isahak MI, Adnan SNN, Noor ZHM, Alvarez-Lozada LA, Garza AQ, Leal AA, Reyes BAF, Guerra EVO, Garza FJA, Mey HEA, Isais JAR, Zertuche JTG, García PLG, Sánchez LAH, Mercado MPF, Sierra OAV, Morales PER, Fuentes SO, Martínez VMP, Guerra-Juárez YA, Flores-González AK, Singh S, Hadi A, Woodbridge C, Thornton-Hume D, Forsythe J, Dharmaratne I, Pai V, Windsor J, Zargar K, Waldin L, Winthrop L, Alvarez M, Huang M, Kumove M, Simonetti M, Chand N, Goldsmith O, Guo O, Monk P, Zhou K, Penneru SH, Prasad S, Ren S, Hill T, Mistry V, Sun S, Pereira A, Mclaughlin S, Stokes A, Sathiyaseelan A, Rossaak J, Lim J, Brooke K, Quinlan L, Pottier M, Podder N, Jinu P, Ramphal S, Vermeulen W, Jeffery F, Busaidi ISA, Divinagracia J, Ju W, Liu Y, Glyn T, Thompson N, Graziadei V, Canton J, Furey J, Choi H, Coomber G, Divekar T, English T, Gernhoefer E, Healy T, Chou J, Parajuli D, Reed C, Studd R, Lin A, Wells C, Xu C, Hadi A, Maccormick A, Park H, Rathnayake A, Williams B, Chan A, Smith C, Casciola F, Bhikha J, Luo J, Yi K, Singhal M, George R, Luo R, Frost T, Hakak F, George A, Carlos A, Ho A, Mcrae C, Lescheid J, Soek J, Pham A, Clair SS, Yee SA, Lim J, Wu CY, Kim T, Chua AQ, Harmston C, Boyes H, Cook H, Struthers J, Radovanovich J, Quek N, Fearnley-Fitzgerald C, Wright D, Ghandi K, Matheson N, McGuinness MJ, Chen B, Douglas RI, Richter K, Soliman NB, Bolam SM, Vimalan V, Currie W, Cuthbert M, Ross P, Nicholson A, Garton B, Agnew E, Conlon N, Waaka N, Kejriwal R, Nguyen S, Leung E, Ratnayake M, Smith Q, Joseph N, Yue B, Fraser C, Lam C, Figgitt E, Liu G, Tan K, You HS, Zheng H, Luo J, Sharp J, Khanna K, Simiona L, Luo M, Ratnayake M, Wong P, Luu R, Paul R, Nair S, Asadyari-Lupo S, Hung W, Ying G, Ho J, Wu A, Walsh E, Lee J, Liu J, Yao S, Nosseir O, Dang J, Young S, Zyul'korneeva S, Boyd T, Ho J, Wu A, Yao S, Kirfi AM, Ningi AB, Garba MA, Salihu MB, Ukwuoma OE, Ibrahim A, Sajo IM, Aminu MB, Usman LH, Lanre ON, Shuaibu IS, Yusuf S, Ismail T, Umar GI, Adeyeye A, Afeikhena E, Nnaji FC, Agu JO, Maxwell TP, Motajo OO, Ifoto O, Okon SAI, Makama JG, Mohammed-Durosinlorun AA, Aminu B, Onwuhafua PI, Mohammed C, Abdulrasheed L, Adze JA, Suleiman KR, Airede LR, Taingson MC, Bature SB, Kache SA, Ogbonna UO, Fufore MB, Iya A, Ajulo AA, Mahmud A, Yahya BS, Onimisi-Yusuf F, Isaac H, Jawa T, Joseph F, Kala B, Bakari MA, Ngwan DW, umar A, Filikus AL, Wycliff D, Okunlola A, Abiola O, Adeniyi A, Adeyemo O, Awoyinka B, Babalola O, Bakare A, Buari T, Okunlola C, Adeleye G, Salawu A, Abiyere H, Ogidi A, Orewole T, Abdullahi HI, Akaba G, Achem A, Bassey AO, Ayogu E, Sulaiman B, Isah DA, Akpamgbo CN, Asudo F, Adewole N, Oguche O, Ejembi P, Sani SA, Andrew PC, Isah A, Eniola B, Songden Z, Agida T, Atim T, Mohammed TO, Raji HO, Ibiyemi F, Salawu H, Fasiku O, Solagbade RS, Shiru MM, Ibraheem GH, Oruade J, Ezeoke G, Chawla T, Aziz AB, Marium A, Waheed AA, Aamir FB, Qureshi F, Ather MH, Ali IFM, Tahir I, Akbar MG, Ukrani RD, Raja S, Virani SS, Noordin S, Rehman SU, Golani S, Aamir SR, Mufarrih SM, Waqar U, Taufiq M, Ammar AS, Ejaz A, Sarwar A, Khalid AU, Khattak S, Imran A, Khalid OB, Kaleem U, Muneer U, Kashaf Y, Zafar F, Zaheer A, Ali M, Shafaat A, Qazi A, Tariq AI, Aslam MN, Ali S, Atiq T, Wasim T, Babar D, Zain A, Ibtisam M, Ahmed U, Aqeel STB, Muhib M, Abbal MA, Khan NA, Javed I, Alkaraja L, Amro D, Manasrah G, Hammouri I, Hilail IA, Zalloum J, Alamlih L, Nasereddin M, Rajabi M, Shalalfeh S, Natsheh Z, Elessi K, Jayyab MA, Astal M, Al-Dahdouh M, Salameh AE, Ayyad A, Dawod N, Alsaid H, Matar I, Hassan M, Bakeer M, Malasah M, Abuhashem S, Salem M, Lunca S, Dimofte MG, Morarasu S, Musina AM, Roata CE, Velenciuc N, Butyrskii A, Bozhko M, Ametov A, Chowdhury S, Bagazi D, Domenech J, Rosello-Añon A, Monis A, Chiappe C, Cuneo B, Clemente-Navarro P, Febre J, Sanz-Romera J, Lopez-Vega M, Miranda I, Valverde-Vazquez R, Garcia S, Sanguesa MJ, Balciscueta Z, Ruiz E, Marco E, Talavera E, Farre J, Bacariza L, Duart M, Ureña V, Carre X, Hamid HKS, Abd-Albain MA, Galal-Eldin S, Sarih M, Adam E, Ismail S, Azhari M, Hassan T, Salaheldein M, Abdalla Z, Ahmed W, Alhassan M, Mohamed A, Suliman HMA, Eltayeb MOM, Ahmed RAA, Babekir EMA, Khairy MAT, Mukhtar MMA, Ali RAH, Al-Shambaty YBA, Yousif FI, Mohammed HMH, Osher L, Osher L, Abdelbast M, Yassin M, Moawia N, Abdalsadeg R, Husein A, Elhassan B, Abdelbagi AY, Adam MA, Ali EM, Mohammed IAB, Mohamed M, Abdulaziz M, Akasha M, Hassan M, Hilal N, Mohamed NAA, Abubaker N, Mohammed O, Mohamed S, Osman W, Mustafa F, Salih AA, Ali D, Almakki DMA, Mohamed HE, Elmubark A, Hassan M, Alnour A, Elaagib A, Abdelrahman A, Abdelkhalig M, Eldaim KN, Babiker A, Ahmed E, Ali M, Hussain E, Wedatalla M, Ahmed A, Hamza AA, Mohammed M, Osman O, Ibrahim R, Ahmed R, Ahmed R, Yasir R, Awadallah S, Mohmmed S, Hassan S, Shaban W, Hussein A, Rafea R, Abdalla A, Ahmed A, Mohamed K, Mohammed M, Altahir M, Adam M, Mohamed O, Abdullah W, Fadlalmola H, Abdalla AY, Omer AA, Mustafa AA, Elhadi REH, Banaga EEA, Osman F, Abdalla MGA, Taha HAM, Abdalmahmoud NE, Nafie RH, Jamal S, Ahmed S, Ali RA, ‏Aladna ‏A, ‏Aljoumaa ‏A, ‏Nawfal ‏H, Jamali S, Khouja ‏F, ‏Niazi ‏A, Al Rawashdeh T‏‏, Kechiche N, Gara M, Nasr M, Baccar M, Benamor O, Chakroun S, Sanli AN, Yildiz A, Demirkiran MA, Atadag YB, Tandogan YI, Ozkan E, Ozer Y, Ozkan E, Oncel MM, Kalkan S, Gover T, Manoglu B, Oksak I, Kurt I, Rifaioglu K, Sokmen S, Bisgin T, Yildirim Y, Keskin AY, Dogan T, Sahin Bİ, Aydin C, Benek DE, Tiras HN, Arslangilay M, Aslangilay M, Yaytokgil M, Capar MA, Yazgan Y, Bektas S, Alagoz AC, Dagsali AE, Izgis A, Uzel K, Soytas M, Cakir N, Askin AE, Azboy I, Sabuncu K, Aslan M, Sahin M, Oncel M, Okkabaz N, Sivrikaya RK, Saylar A, Saylar A, Yasar M, Erginoz E, Bozkir HO, Zengin K, Ozcelik MF, Uludag SS, Ozdemir Z, Sibic O, Telci H, Bozkurt MA, Kara Y, Tepe MD, Gündoğdu A, Akın B, Pehlivan D, Guner A, Baysallar D, Yıldız B, Cepe H, Reis ME, Yuzgec AN, Kıralı N, Kodalak TA, Ulusahin M, Selim K, Kale A, Gecici ME, Ozbilen M, Düzyol Z, Gemici A, Korkmaz E, Şen E, Taşcı ME, Camkıran E, Elieyioğlu G, Kayabaş İ, Uprak TK, Aral C, Saraçoğlu A, Uğurlu MÜ, Baltacı ZH, Akkaya EN, Fergar C, Tabak EZ, Kocyigit GZ, Kayilioglu I, Polat S, Çolak E, Kara ME, Candan M, Uyanık MS, Sarı AC, Ulkucu A, Certel AT, Dindar A, Durdu B, Bayram C, Kaya E, Akdere H, Cakcak IE, Yavuz I, Omur M, Ajredini M, Aydoğdu EO, Şenödeyici E, Koksoy UC, Kazbek BK, Korkmaz DS, Yavuz D, Yilmaz H, Cetınkaya ZS, Durmus E, Tuzuner F, Hokelekli F, Mutlu M, Akbuz SO, Kus ZC, Kus ZC, Farrell M, Craig-Lucas A, Painter M, Titan A, Narayan A, Fariyike B, Knowlton L, Yue T, Benham E, Nimeri A, Werenski H, Kaiser N, Reinke C. Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries. Br J Surg 2024;111:znad421. [PMID: 38207169 PMCID: PMC10783642 DOI: 10.1093/bjs/znad421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Revised: 11/29/2023] [Accepted: 12/05/2023] [Indexed: 01/13/2024] Abstract BACKGROUND Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures. METHODS This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge. RESULTS The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (β coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not. CONCLUSION Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely. Collapse Key Words Collapse MESH Headings Humans Analgesics, Opioid/therapeutic use Patient Satisfaction Patient Discharge Prospective Studies Pain Measurement Pain, Postoperative/drug therapy Pain, Postoperative/prevention & control Practice Patterns, Physicians' Analgesia/methods Collapse Grants 213122 Maurice and Phyllis Paykel Trust Surgical Research Funds, University of Newcastle, Australia. Collapse Affiliation(s) Collapse

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Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries. Br J Surg 2024;111:znad421. [PMID: 38207169 PMCID: PMC10783642 DOI: 10.1093/bjs/znad421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Revised: 11/29/2023] [Accepted: 12/05/2023] [Indexed: 01/13/2024]

Abstract

BACKGROUND

Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.

METHODS

This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.

RESULTS

The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (β coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.

CONCLUSION

Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely.

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