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Kwasnicki RM, Giannas E, Rizk C, Kungwengwe G, Dutta T, Dunne J, Dex E, Gokani V, Henry FP, Hunter JE, Williams G, Abela C, Warren O, Jones RP, Wood SH. Quantifying postoperative recovery using wearable activity monitors following abdominal wall surgery: The AbTech trial. J Plast Reconstr Aesthet Surg 2024; 93:281-289. [PMID: 38728901 DOI: 10.1016/j.bjps.2024.04.048] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 04/08/2024] [Accepted: 04/14/2024] [Indexed: 05/12/2024]
Abstract
PURPOSE This work aimed to investigate the validity of wearable activity monitors (WAMs) as an objective tool to measure the return toward normal functional mobility following abdominal wall surgery. This was achieved by quantifying and comparing pre- and postoperative physical activity (PA). METHODS A multicenter, prospective, observational cohort study was designed. Patients undergoing abdominal wall surgery were assessed for eligibility and consent for study participation was obtained. Participants were asked to wear a WAM (AX3, Axivity) on the wrist of their dominant hand at least 48 hours pre-operatively, for up to 2 weeks postop, and again after 6 months postop for 48 hours. RESULTS A cohort of 20 patients were recruited in this validation study with a mean age of 47.3 ± 13.0 years. Postoperation, the percentage median PA (±IQR) dropped to 32.6% (20.1), whereas on day 14, PA had reached 64.6% (22.7) of the preoperative value providing construct validity. Activity levels at >6 months postop increased by 16.4% on an average when compared to baseline preoperative PA (p = 0.046). CONCLUSION This study demonstrates that WAMs are valid markers of postoperative recovery following abdominal wall surgery. This was achieved by quantifying the reduction in PA postoperation, which has not been previously shown. In addition, this study suggests that abdominal wall surgery may improve the patient's quality of life via increased functional mobility at 6 months postop. In the future, this technology could be used to identify the patient and surgical factors that are predictors of outcome following abdominal wall surgery.
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Affiliation(s)
- Richard Mark Kwasnicki
- Department of Surgery and Cancer, Imperial College London, London, UK; Department of Plastic and Reconstructive Surgery, Imperial College Healthcare NHS Trust, London UK.
| | - Emmanuel Giannas
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Chiara Rizk
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Garikai Kungwengwe
- Department of Plastic and Reconstructive Surgery, Chelsea and Westminster NHS Trust, London, UK
| | - Tanusree Dutta
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Jonathan Dunne
- Department of Plastic and Reconstructive Surgery, Imperial College Healthcare NHS Trust, London UK
| | - Elizabeth Dex
- Department of Plastic and Reconstructive Surgery, Imperial College Healthcare NHS Trust, London UK
| | - Vimal Gokani
- Department of Plastic and Reconstructive Surgery, Imperial College Healthcare NHS Trust, London UK
| | - Francis P Henry
- Department of Plastic and Reconstructive Surgery, Imperial College Healthcare NHS Trust, London UK
| | - Judith E Hunter
- Department of Plastic and Reconstructive Surgery, Imperial College Healthcare NHS Trust, London UK
| | - Georgina Williams
- Department of Plastic and Reconstructive Surgery, Imperial College Healthcare NHS Trust, London UK
| | - Chris Abela
- Department of Plastic and Reconstructive Surgery, Chelsea and Westminster NHS Trust, London, UK
| | - Oliver Warren
- Department of General Surgery, Chelsea and Westminster NHS Trust, London, UK
| | - Rowan Pritchard Jones
- Department of Plastic and Reconstructive Surgery, Mersey and West Lancashire Teaching Hospitals NHS Trust, London, UK
| | - Simon H Wood
- Department of Plastic and Reconstructive Surgery, Imperial College Healthcare NHS Trust, London UK
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2
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Cross KLR, Brown SR, Kleijnen J, Bunce J, Paul M, Pilkington S, Warren O, Jones O, Lund J, Goss HJ, Stanton M, Marunda T, Gilani A, Ngu LWS, Tozer P. The Association of Coloproctology of Great Britain and Ireland guideline on the management of anal fissure. Colorectal Dis 2023; 25:2423-2457. [PMID: 37926920 DOI: 10.1111/codi.16762] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Revised: 07/24/2023] [Accepted: 08/03/2023] [Indexed: 11/07/2023]
Abstract
AIM The management of anal fissure: ACPGBI position statement was written 15 years ago. [KLR Cross et al., Colorectal Dis, 2008]. Our aim was to update the guideline and provide recommendations on the most effective treatment for patients with anal fissures utilising a multidisciplinary, rigorous guideline methodology. METHODS The development process consisted of six phases. In phase 1 we defined the scope of the guideline. The patient population included patients with acute and chronic anal fissure. The target group was all practitioners (primary and secondary care) treating patients with fissures and, in addition, healthcare workers and patients who desired information regarding fissure management. In phase 2 we formed a guideline development group (GDG) including a methodologist. In phase 3 review questions were formulated, using a reversed PICO process, starting with possible recommendations based on the GDG's knowledge. In phase 4 a comprehensive literature search focused on existing systematic reviews addressing each review question, supplemented by more recent studies if appropriate. In phase 5 data were extracted from the included papers and checked by the GDG. If indicated, meta-analysis of systematic review data was updated by the GDG. During phase 6 the GDG members decided what recommendations could be made based on the evidence in the literature and strength of the recommendation was assessed using 'grade'. RESULTS This guideline is divided into two sections: Primary care which includes (i) diagnosis; (ii) basic treatment; (iii) topical treatment; and secondary care which includes (iv) botulinum toxin therapy; (v) surgical intervention and (vi) special situations (including pregnancy and breast-feeding patients, children, receptive anal intercourse and low-pressure fissures). A total of 23 recommendations were formulated. A new term clinically healed was described by the GDG. CONCLUSION This guideline provides an up-to-date evidence-based summary of the current knowledge of the management of anal fissure and may serve as a useful guide for clinicians as well as a potential reference for patients.
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Affiliation(s)
- Katie L R Cross
- Department of General Surgery, Royal Devon Healthcare Trust, Barnstaple, UK
| | - Steven R Brown
- Department of Surgery, Sheffield Teaching Hospitals, Sheffield, UK
| | | | - James Bunce
- Royal Derby Hospital, The University of Nottingham, Nottingham, UK
| | - Melanie Paul
- Department of Surgery, Royal Derby Hospital, Derby, UK
| | | | - Oliver Warren
- Department of Colorectal Surgery, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
- Department of Cancer and Surgery, Imperial College London, London, UK
| | - Oliver Jones
- Department of Colorectal Surgery, Churchill Hospital, Oxford, UK
| | - Jon Lund
- Department of Surgery, Royal Derby Hospital, Derby, UK
| | - Henry J Goss
- Pharmacy Department, Royal Devon Healthcare Trust, Southampton, UK
| | - Michael Stanton
- Department of Paediatric Surgery, University Hospital, Southampton, UK
| | - Tatenda Marunda
- St Mark's Hospital, London North West University Healthcare Trust, Harrow, UK
| | - Artaza Gilani
- UCL Research Department of Primary Care and Population Health, University College London Medical School (Royal Free Hospital Campus), London, UK
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3
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Grove TN, Bainton T, Celentano V, Raza A, Warren O. Excision of anterior abdominal wall endometriotic nodule and reconstruction-A video vignette. Colorectal Dis 2022; 25:814-815. [PMID: 36300692 DOI: 10.1111/codi.16390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 10/05/2022] [Accepted: 10/08/2022] [Indexed: 02/08/2023]
Affiliation(s)
- Thomas N Grove
- Chelsea and Westminster Hospital, London, UK.,Imperial College London, London, UK
| | - Thomas Bainton
- Chelsea and Westminster Hospital, London, UK.,Imperial College London, London, UK
| | | | - Amer Raza
- Chelsea and Westminster Hospital, London, UK.,Imperial College London, London, UK
| | - Oliver Warren
- Chelsea and Westminster Hospital, London, UK.,Imperial College London, London, UK
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4
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Celentano V, Rafique H, Jerome M, Lee YJ, Kontovounisious C, Warren O, MacDonald A, Wahed M, Mills S, Tekkis P. Development of a specialist ileoanal pouch surgery pathway: a multidisciplinary patient-centred approach. Frontline Gastroenterol 2022; 14:244-248. [PMID: 37056326 PMCID: PMC10086703 DOI: 10.1136/flgastro-2022-102267] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 10/10/2022] [Indexed: 11/07/2022] Open
Abstract
Background Restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA) is the gold standard procedure for ulcerative colitis refractory to medical treatment, as an alternative to permanent end ileostomy. Gaining experience in pouch surgery is difficult as the procedure is performed infrequently. This study presents an institutional initiative to promote standardisation of multidisciplinary care in IPAA surgery. Methods A dedicated pathway for patients who had an IPAA or are considering IPAA surgery was developed among colorectal surgeons, gastroenterologists, paediatric colorectal surgeons, inflammatory bowel disease (IBD) nurses, dietitians, stoma nurses, trainees in colorectal surgery. Pathway items were discussed and finalised via emails and videoconferences.The pathway included triaging of patients referred for IPAA surgery, preoperative IBD multidisciplinary team discussion and management plan for surgery, surgical review prior to surgery, peer to peer counselling, surgical technique, postoperative short-term and long-term follow-up, audit, research and training in IPAA surgery. Results A multidisciplinary preoperative pathway was developed and a stepwise approach to minimally invasive ileoanal pouch surgery was formalised. A dedicated one-stop ileoanal pouch clinic was established integrating endoscopy and imaging on the same day of the consultation with the surgical and gastroenterology team. The clinic reviewed 72 patients over 24 months, and during the same time 36 patients underwent IPAA surgery at our institution. Conclusions We have described our initial experience in establishing a specialist IPAA surgery pathway and have proposed outcome measures that we hope will support a subspecialty IPAA service.
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Affiliation(s)
- Valerio Celentano
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Henna Rafique
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Melanie Jerome
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Yu Jin Lee
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Christos Kontovounisious
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Oliver Warren
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Alexander MacDonald
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Mahmood Wahed
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Sarah Mills
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Paris Tekkis
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
- Department of Surgery and Cancer, Imperial College London, London, UK
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5
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Grove T, Howell AM, Kontovounisios C, Nicolay C, Mehta A, Warren O. P-012 ESTABLISHING THE NORTH-WEST LONDON MDT FOR COMPLEX ABDOMINAL RECONSTRUCTION: OUR EXPERIENCE. Br J Surg 2022. [DOI: 10.1093/bjs/znac308.112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract
Aim
Complex patients have been shown to have favourable outcomes when managed under the care of the multi-disciplinary teams (MDT) 1,2. In 2019 we published our experience of a single centre complex AWH MDT and advocated its use 3 in line with EHS and a collaborative group from AWRE 2020 4,5.
Expansion
Further development has led to the set-up of a regional, tertiary, complex, abdominal wall reconstruction MDT service. This has facilitated identification of patients who will ultimately benefit from management of the regional AWH MDT surgical teams undertaking the most complex of abdominal wall procedures together.
Since 2021 our regional MDT discussed 87 cases including tertiary referrals from within and out with the immediate geographical area. 71 abdominal wall hernias including 15 recurrent, 6 with concurrent parastomal hernias, 9 parastomal hernias and one perineal hernia.
Progression
The development of virtual conferencing services has allowed the MDT improved access for healthcare professionals. With resources for benign cases becoming increasing restricted, having an MDT approved management plan for patients streamlines services and allows costs to be rationalised. Scheduling joint operations between different hospitals facilitates pooling of expertise for difficult cases.
We are developing an online registry for involved abdominal wall units to allow data sharing, service evaluation and improve accountability.
Conclusion
Appreciation of complex abdominal wall surgery as a stand-alone sub-specialty is increasing and there is a consensus among hernia surgeons that these patients should be managed by the MDT in specialist centres by specialist surgeons enhancing learning, proficiency, and accountability.
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Affiliation(s)
- T Grove
- Surgery, Chelsea and Westminster Hospital , London , United Kingdom
| | - A M Howell
- Surgery, Chelsea and Westminster Hospital , London , United Kingdom
| | - C Kontovounisios
- Surgery, Chelsea and Westminster Hospital , London , United Kingdom
| | - C Nicolay
- Surgery, Chelsea and Westminster Hospital , London , United Kingdom
| | - A Mehta
- Surgery, St Marks Hospital , London , United Kingdom
| | - O Warren
- Surgery, Chelsea and Westminster Hospital , London , United Kingdom
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6
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Celentano V, Tekkis P, Nordenvall C, Mills S, Spinelli A, Smart N, Selvaggi F, Warren O, Espin-Basany E, Kontovounisios C, Pellino G, Warusavitarne J, Hancock L, Myrelid P, Remzi F. Standardization of ileoanal J-pouch surgery technique: Quality assessment of minimally invasive ileoanal J-pouch surgery videos. Surgery 2022; 172:53-59. [PMID: 34980484 DOI: 10.1016/j.surg.2021.11.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 11/18/2021] [Accepted: 11/29/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Ileal pouch anal anastomosis is a complex procedure associated with significant morbidity, with several complications after ileal pouch anal anastomosis surgery leading to pouch failure. The aim of the study is to evaluate the heterogeneity surrounding the technique of ileoanal J-pouch surgery by assessing the safety and quality of published online peer-reviewed surgical videos. METHODS Ileal pouch anal anastomosis videos published on peer-reviewed surgical journals and video channels were edited and anonymized to demonstrate specific steps of the surgical procedure: mobilization and division of the rectum, formation of the ileoanal J-pouch reservoir, anastomosis, and lengthening techniques. The anonymized videos were presented to a group of reviewers with expertise in ileal pouch anal anastomosis blinded to the names and affiliations of the surgeons performing the procedure. Primary outcome was the rate of interobserver variability in the assessment of specific technical steps of the ileal pouch anal anastomosis surgery procedure. Secondary outcome was the appropriateness of the use of surgical videos review as an assessment tool for ileal pouch anal anastomosis surgery, measured as rate of reviewers being unable to answer for poor video quality. RESULTS In total, 29 video fragments were distributed, and 13 assessors completed a 60-item survey, organized in 7 major domains. The survey completion rate was 93.4%. Out of a total 729 answers, in 23 (3.2%) the reviewers indicated they were unable to comment due to poor video image, and in 48 (6.5%) were unable to comment due to the particular step not being shown in the procedure. The proportion of assessors rating rectal mobilization technically appropriate ranged from 30.7% to 92.3% and from 7.7% to 69.2% for safety. The level of rectal division was considered appropriate in 0 to 53.8% of the videos, whereas the stapling technique used for rectal division was appropriate in 0 to 70% of the videos. CONCLUSION Our study assessed published peer-reviewed videos on ileal pouch anal anastomosis surgery and reported heterogeneity in the safety of the demonstrated techniques. Blind assessment of published peer-reviewed ileal pouch anal anastomosis videos reported a high rate of unsafe or inappropriate technique for rectal mobilization and transection in the reviewed videos, with fair interobserver agreement among reviewers. There is a need for consensus on what is considered safe and appropriate in ileal pouch anal anastomosis surgery. Peer review of ileal pouch anal anastomosis surgery videos could facilitate training and accreditation in this complex procedure.
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Affiliation(s)
- Valerio Celentano
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK; Department of Surgery and Cancer, Imperial College, London, UK.
| | - Paris Tekkis
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK; Department of Surgery and Cancer, Imperial College, London, UK
| | - Caroline Nordenvall
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Department of Pelvic Cancer, Karolinska University Hospital, Stockholm, Sweden
| | - Sarah Mills
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK; Department of Surgery and Cancer, Imperial College, London, UK
| | - Antonino Spinelli
- Humanitas Clinical and Research Center IRCCS, Division of Colon and Rectal Surgery, Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Neil Smart
- Exeter Health Services, Research Unit, Royal Devon & Exeter Hospital, UK
| | - Francesco Selvaggi
- Department of Advanced Medical and Surgical Sciences, Universita' degli Studi della Campania "Luigi Vanvitelli," Naples, Italy
| | - Oliver Warren
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK; Department of Surgery and Cancer, Imperial College, London, UK
| | - Eloy Espin-Basany
- Colorectal Surgery, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Christos Kontovounisios
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK; Department of Surgery and Cancer, Imperial College, London, UK
| | - Gianluca Pellino
- Department of Advanced Medical and Surgical Sciences, Universita' degli Studi della Campania "Luigi Vanvitelli," Naples, Italy; Colorectal Surgery, Vall d'Hebron University Hospital, Barcelona, Spain
| | | | - Laura Hancock
- Manchester University NHS Foundation Trust, Manchester, UK
| | - Par Myrelid
- Division of Surgery, Department of Biomedical and Clinical Sciences, Faulty of Health Sciences, Linköping University, Sweden; Department of Surgery, County Council of Östergötland Linköping, Sweden
| | - Feza Remzi
- Inflammatory Bowel Disease Center, NYU Langone Health, New York, NY; NYU Grossman School of Medicine, New York, NY
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7
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Plumb AA, Rajeswaran G, Abbasi MA, Masci L, Warren O, Wilson J. Contemporary imaging of inguinal hernia and pain. Br J Radiol 2022; 95:20220163. [DOI: 10.1259/bjr.20220163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Inguinal hernias are the commonest type of hernia, and are frequently encountered by general, abdominal and musculoskeletal radiologists. Such hernias may cause discomfort or pain; but many other conditions may cause pain in a similar location, meaning it is not always straightforward to determine the underlying cause of a particular patient’s symptoms. Although surgical fixation of hernia has high success rates with low recurrence, ongoing symptoms are common after apparently uncomplicated surgery. In particular, post-surgical chronic groin pain can be highly problematic in some patients. In this review, we highlight the relevant surgical and imaging anatomy, common modes of clinical presentation, contemporary surgical approaches to the repair of inguinal hernia, imaging techniques to diagnose such hernias in both unoperated and operated groins and mimics of hernia-related pain.
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Affiliation(s)
- Andrew A Plumb
- Department of Radiology, University College London Hospitals NHS Foundation Trust, London, UK
| | | | - Maaz Ali Abbasi
- Department of Radiology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Lorenzo Masci
- Department of Orthopaedics and Sports Medicine, OneWelbeck, London, United Kingdom
| | - Oliver Warren
- Department of Surgery, Chelsea and Westminster Hospital, London, United Kingdom
- Digestive Surgery, OneWelbeck, London, United Kingdom
| | - Jonathan Wilson
- Digestive Surgery, OneWelbeck, London, United Kingdom
- Department of Surgery, The Whittington Hospital, London, United Kingdom
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8
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Fadel M, Hamrang-Yousefi S, Mills S, Warren O, Tekkis P, Kontovounisios C. 1252 A Systematic Review of International Colorectal Multidisciplinary Team Meetings: The Development of Best Practice Through Inter-Regional Learning. Br J Surg 2021. [DOI: 10.1093/bjs/znab259.423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Aim
Colorectal multi-disciplinary teams (CR MDTs) were introduced to enhance the cancer care pathway and allow for early investigation and treatment of colorectal cancer. However, there are no gold standards set for this process. The aim of this study is to establish recommendations on the principles, organisation, structure and output of CR MDTs internationally.
Method
The available literature on the role of CR MDTs from January 1999 and March 2020 in the United Kingdom (UK), United States of America (USA) and continental Europe was evaluated. Historical background, structure, core members, education, frequency, patient selection criteria, quality assurance, output and outcomes were extracted from data from the UK, USA, and continental Europe.
Results
Fifty studies were identified that specifically met the inclusion criteria. CR MDTs should occur at least once a month with established key members. Generally, all colorectal cancer patients should be discussed and there should be a focus on education. There are noted differences in the lead member of the CR MDT, the use of information technology and storage of MDT information in databases and quality assurance internationally.
Conclusions
The most common issues facing MDTs internationally include a lack of staffing and resources as well as limited information on the patient’s fitness and preference for surgery. These factors are important and urgent improvements are required in these areas in CR MDTs. Quality assurance should be a mandatory component of every CR MDT.
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Affiliation(s)
- M Fadel
- Chelsea and Westminster Hospital, London, United Kingdom
| | | | - S Mills
- Chelsea and Westminster Hospital, London, United Kingdom
| | - O Warren
- Chelsea and Westminster Hospital, London, United Kingdom
| | - P Tekkis
- Chelsea and Westminster Hospital, London, United Kingdom
- Royal Marsden Hospital, London, United Kingdom
- Imperial College London, London, United Kingdom
| | - C Kontovounisios
- Chelsea and Westminster Hospital, London, United Kingdom
- Royal Marsden Hospital, London, United Kingdom
- Imperial College London, London, United Kingdom
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9
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Bainton T, Celentano V, Phillips J, Warren O, Richardson R, Raza A. Laparoscopic resection of rectovaginal endometriosis involving segmental bowel resection and anastomosis: preoperative planning, intra-operative decision-making, description of technique, and tips and tricks for a successful outcome - a video vignette. Colorectal Dis 2021; 23:2208-2210. [PMID: 33998123 DOI: 10.1111/codi.15737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 04/29/2021] [Accepted: 05/03/2021] [Indexed: 02/08/2023]
Affiliation(s)
| | | | | | - Oliver Warren
- Chelsea and Westminster Hospital, London, UK.,Department of Surgery and Cancer, Imperial College London, London, UK
| | | | - Amer Raza
- Chelsea and Westminster Hospital, London, UK
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Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries. Lancet 2021; 397:387-397. [PMID: 33485461 PMCID: PMC7846817 DOI: 10.1016/s0140-6736(21)00001-5] [Citation(s) in RCA: 104] [Impact Index Per Article: 34.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 12/02/2020] [Accepted: 12/17/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. METHODS This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. FINDINGS Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70-8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39-8·80) and upper-middle-income countries (2·06, 1·11-3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26-11·59) and upper-middle-income countries (3·89, 2·08-7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. INTERPRETATION Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. FUNDING National Institute for Health Research Global Health Research Unit.
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Courtney A, Howell AM, Daulatzai N, Savva N, Warren O, Mills S, Rasheed S, Milind G, Tekkis N, Gardiner M, Dai T, Safar B, Efron JE, Darzi A, Tekkis P, Kontovounisios C. CRC COVID: Colorectal cancer services during COVID-19 pandemic. Study protocol for service evaluation. Int J Surg Protoc 2020; 23:15-19. [PMID: 32835148 PMCID: PMC7417919 DOI: 10.1016/j.isjp.2020.07.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 07/27/2020] [Accepted: 07/30/2020] [Indexed: 11/04/2022] Open
Abstract
COVID-19 disrupted healthcare provision worldwide. This is a four-phase multi-centre service evaluation of colorectal cancer services. Conducted through a research collaborative in the UK, Ireland and the USA. The aim is to evaluate the impact of the COVID-19 pandemic on service provision.
Introduction COVID-19 has had an impact on the provision of colorectal cancer care. The aim of the CRC COVID study is to describe the changes in colorectal cancer services in the UK and USA in response to the pandemic and to understand the long-term impact. Methods and analysis This study comprises 4 phases. Phase 1 is a survey of colorectal units that aims to evaluate adherences and deviations from the best practice guidelines during the COVID-19 pandemic. Phase 2 is a monthly prospective data collection of service provision that aims to determine the impact of the service modifications on the long-term cancer specific outcomes compared to the national standards. Phase 3 aims to predict costs attributable to the modifications of the CRC services and additional resources required to treat patients whose treatment has been affected by the pandemic. Phase 4 aims to compare the impact of COVID-19 on the NHS and USA model of healthcare in terms of service provision and cost, and to propose a standardised model of delivering colorectal cancer services for future outbreaks. Ethics and dissemination This study is a service evaluation and does not require HRA Approval or Ethical Approval in the UK. Local service evaluation registration is required for each participating centre. In the USA, Ethical Approval was granted by the Research and Development Committee. The results of this study will be disseminated to stakeholders, submitted for peer review publications, conference presentations and circulated via social media. Registration details Nil.
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Affiliation(s)
- Alona Courtney
- Imperial College London, Department of Surgery and Cancer, Chelsea & Westminster Campus, 369 Fulham Rd, Chelsea, London SW10 9NH, United Kingdom.,Chelsea & Westminster Hospital, 369 Fulham Rd, Chelsea, London SW10 9NH, United Kingdom
| | - Ann-Marie Howell
- Chelsea & Westminster Hospital, 369 Fulham Rd, Chelsea, London SW10 9NH, United Kingdom
| | - Najib Daulatzai
- Chelsea & Westminster Hospital, 369 Fulham Rd, Chelsea, London SW10 9NH, United Kingdom
| | - Nicos Savva
- London Business School, Regent's Park, London NW1 4SA, United Kingdom
| | - Oliver Warren
- Chelsea & Westminster Hospital, 369 Fulham Rd, Chelsea, London SW10 9NH, United Kingdom
| | - Sarah Mills
- Chelsea & Westminster Hospital, 369 Fulham Rd, Chelsea, London SW10 9NH, United Kingdom
| | - Shahnawaz Rasheed
- Royal Marsden Hospital, 203 Fulham Rd, Chelsea, London SW3 6JJ, United Kingdom
| | - Goel Milind
- London Business School, Regent's Park, London NW1 4SA, United Kingdom
| | - Nicholas Tekkis
- University of Cambridge School of Clinical Medicine, Hills Road, Cambridge CB2 0SP, United Kingdom
| | - Matthew Gardiner
- Kennedy Institute of Rheumatology, University of Oxford, Roosevelt Drive, Headington, Oxford OX3 7FY, United Kingdom
| | - Tinglong Dai
- Johns Hopkins University Carey Business School, The Charm'tastic Mile, 100 International Drive, Baltimore, MD 21202, United States
| | - Bashar Safar
- Johns Hopkins Hospital, 1800 Orleans St, Baltimore, MD 21287, United States
| | - Jonathan E Efron
- Johns Hopkins Hospital, 1800 Orleans St, Baltimore, MD 21287, United States
| | - Ara Darzi
- Imperial College London, Department of Surgery and Cancer, Queen Elizabeth the Queen Mother Wing (QEQM), St Mary's Campus, Praed St, Paddington, London W2 1NY, United Kingdom
| | - Paris Tekkis
- Imperial College London, Department of Surgery and Cancer, Chelsea & Westminster Campus, 369 Fulham Rd, Chelsea, London SW10 9NH, United Kingdom.,Royal Marsden Hospital, 203 Fulham Rd, Chelsea, London SW3 6JJ, United Kingdom
| | - Christos Kontovounisios
- Imperial College London, Department of Surgery and Cancer, Chelsea & Westminster Campus, 369 Fulham Rd, Chelsea, London SW10 9NH, United Kingdom.,Chelsea & Westminster Hospital, 369 Fulham Rd, Chelsea, London SW10 9NH, United Kingdom.,Royal Marsden Hospital, 203 Fulham Rd, Chelsea, London SW3 6JJ, United Kingdom
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McLean KA, Ahmed WUR, Akhbari M, Claireaux HA, English C, Frost J, Henshall DE, Khan M, Kwek I, Nicola M, Rehman S, Varghese S, Drake TM, Bell S, Nepogodiev D, McLean KA, Drake TM, Glasbey JC, Borakati A, Drake TM, Kamarajah S, McLean KA, Bath MF, Claireaux HA, Gundogan B, Mohan M, Deekonda P, Kong C, Joyce H, Mcnamee L, Woin E, Burke J, Khatri C, Fitzgerald JE, Harrison EM, Bhangu A, Nepogodiev D, Arulkumaran N, Bell S, Duthie F, Hughes J, Pinkney TD, Prowle J, Richards T, Thomas M, Dynes K, Patel M, Patel P, Wigley C, Suresh R, Shaw A, Klimach S, Jull P, Evans D, Preece R, Ibrahim I, Manikavasagar V, Smith R, Brown FS, Deekonda P, Teo R, Sim DPY, Borakati A, Logan AE, Barai I, Amin H, Suresh S, Sethi R, Bolton W, Corbridge O, Horne L, Attalla M, Morley R, Robinson C, Hoskins T, McAllister R, Lee S, Dennis Y, Nixon G, Heywood E, Wilson H, Ng L, Samaraweera S, Mills A, Doherty C, Woin E, Belchos J, Phan V, Chouari T, Gardner T, Goergen N, Hayes JDB, MacLeod CS, McCormack R, McKinley A, McKinstry S, Milligan W, Ooi L, Rafiq NM, Sammut T, Sinclair E, Smith M, Baker C, Boulton APR, Collins J, Copley HC, Fearnhead N, Fox H, Mah T, McKenna J, Naruka V, Nigam N, Nourallah B, Perera S, Qureshi A, Saggar S, Sun L, Wang X, Yang DD, Caroll P, Doyle C, Elangovan S, Falamarzi A, Perai KG, Greenan E, Jain D, Lang-Orsini M, Lim S, O'Byrne L, Ridgway P, Van der Laan S, Wong J, Arthur J, Barclay J, Bradley P, Edwin C, Finch E, Hayashi E, Hopkins M, Kelly D, Kelly M, McCartan N, Ormrod A, Pakenham A, Hayward J, Hitchen C, Kishore A, Martins T, Philomen J, Rao R, Rickards C, Burns N, Copeland M, Durand C, Dyal A, Ghaffar A, Gidwani A, Grant M, Gribbon C, Gruhn A, Leer M, Ahmad K, Beattie G, Beatty M, Campbell G, Donaldson G, Graham S, Holmes D, Kanabar S, Liu H, McCann C, Stewart R, Vara S, Ajibola-Taylor O, Andah EJE, Ani C, Cabdi NMO, Ito G, Jones M, Komoriyama A, Patel P, Titu L, Basra M, Gallogly P, Harinath G, Leong SH, Pradhan A, Siddiqui I, Zaat S, Ali A, Galea M, Looi WL, Ng JCK, Atkin G, Azizi A, Cargill Z, China Z, Elliot J, Jebakumar R, Lam J, Mudalige G, Onyerindu C, Renju M, Babu VS, Hussain M, Joji N, Lovett B, Mownah H, Ali B, Cresswell B, Dhillon AK, Dupaguntla YS, Hungwe C, Lowe-Zinola JD, Tsang JCH, Bevan K, Cardus C, Duggal A, Hossain S, McHugh M, Scott M, Chan F, Evans R, Gurung E, Haughey B, Jacob-Ramsdale B, Kerr M, Lee J, McCann E, O'Boyle K, Reid N, Hayat F, Hodgson S, Johnston R, Jones W, Khan M, Linn T, Long S, Seetharam P, Shaman S, Smart B, Anilkumar A, Davies J, Griffith J, Hughes B, Islam Y, Kidanu D, Mushaini N, Qamar I, Robinson H, Schramm M, Tan CY, Apperley H, Billyard C, Blazeby JM, Cannon SP, Carse S, Göpfert A, Loizidou A, Parkin J, Sanders E, Sharma S, Slade G, Telfer R, Huppatz IW, Worley E, Chandramoorthy L, Friend C, Harris L, Jain P, Karim MJ, Killington K, McGillicuddy J, Rafferty C, Rahunathan N, Rayne T, Varathan Y, Verma N, Zanichelli D, Arneill M, Brown F, Campbell B, Crozier L, Henry J, McCusker C, Prabakaran P, Wilson R, Asif U, Connor M, Dindyal S, Math N, Pagarkar A, Saleem H, Seth I, Sharma S, Standfield N, Swartbol T, Adamson R, Choi JE, El Tokhy O, Ho W, Javaid NR, Kelly M, Mehdi AS, Menon D, Plumptre I, Sturrock S, Turner J, Warren O, Crane E, Ferris B, Gadsby C, Smallwood J, Vipond M, Wilson V, Amarnath T, Doshi A, Gregory C, Kandiah K, Powell B, Spoor H, Toh C, Vizor R, Common M, Dunleavy K, Harris S, Luo C, Mesbah Z, Kumar AP, Redmond A, Skulsky S, Walsh T, Daly D, Deery L, Epanomeritakis E, Harty M, Kane D, Khan K, Mackey R, McConville J, McGinnity K, Nixon G, Ang A, Kee JY, Leung E, Norman S, Palaniappan SV, Sarathy PP, Yeoh T, Frost J, Hazeldine P, Jones L, Karbowiak M, Macdonald C, Mutarambirwa A, Omotade A, Runkel M, Ryan G, Sawers N, Searle C, Suresh S, Vig S, Ahmad A, McGartland R, Sim R, Song A, Wayman J, Brown R, Chang LH, Concannon K, Crilly C, Arnold TJ, Burgin A, Cadden F, Choy CH, Coleman M, Lim D, Luk J, Mahankali-Rao P, Prudence-Taylor AJ, Ramakrishnan D, Russell J, Fawole A, Gohil J, Green B, Hussain A, McMenamin L, McMenamin L, Tang M, Azmi F, Benchetrit S, Cope T, Haque A, Harlinska A, Holdsworth R, Ivo T, Martin J, Nisar T, Patel A, Sasapu K, Trevett J, Vernet G, Aamir A, Bird C, Durham-Hall A, Gibson W, Hartley J, May N, Maynard V, Johnson S, Wood CM, O'Brien M, Orbell J, Stringfellow TD, Tenters F, Tresidder S, Cheung W, Grant A, Tod N, Bews-Hair M, Lim ZH, Lim SW, Vella-Baldacchino M, Auckburally S, Chopada A, Easdon S, Goodson R, McCurdie F, Narouz M, Radford A, Rea E, Taylor O, Yu T, Alfa-Wali M, Amani L, Auluck I, Bruce P, Emberton J, Kumar R, Lagzouli N, Mehta A, Murtaza A, Raja M, Dennahy IS, Frew K, Given A, He YY, Karim MA, MacDonald E, McDonald E, McVinnie D, Ng SK, Pettit A, Sim DPY, Berthaume-Hawkins SD, Charnley R, Fenton K, Jones D, Murphy C, Ng JQ, Reehal R, Robinson H, Seraj SS, Shang E, Tonks A, White P, Yeo A, Chong P, Gabriel R, Patel N, Richardson E, Symons L, Aubrey-Jones D, Dawood S, Dobrzynska M, Faulkner S, Griffiths H, Mahmood F, Patel P, Perry M, Power A, Simpson R, Ali A, Brobbey P, Burrows A, Elder P, Ganyani R, Horseman C, Hurst P, Mann H, Marimuthu K, McBride S, Pilsworth E, Powers N, Stanier P, Innes R, Kersey T, Kopczynska M, Langasco N, Patel N, Rajagopal R, Atkins B, Beasley W, Lim ZC, Gill A, Ang HL, Williams H, Yogeswara T, Carter R, Fam M, Fong J, Latter J, Long M, Mackinnon S, McKenzie C, Osmanska J, Raghuvir V, Shafi A, Tsang K, Walker L, Bountra K, Coldicutt O, Fletcher D, Hudson S, Iqbal S, Bernal TL, Martin JWB, Moss-Lawton F, Smallwood J, Vipond M, Cardwell A, Edgerton K, Laws J, Rai A, Robinson K, Waite K, Ward J, Youssef H, Knight C, Koo PY, Lazarou A, Stanger S, Thorn C, Triniman MC, Botha A, Boyles L, Cumming S, Deepak S, Ezzat A, Fowler AJ, Gwozdz AM, Hussain SF, Khan S, Li H, Morrell BL, Neville J, Nitiahpapand R, Pickering O, Sagoo H, Sharma E, Welsh K, Denley S, Khan S, Agarwal M, Al-Saadi N, Bhambra R, Gupta A, Jawad ZAR, Jiao LR, Khan K, Mahir G, Singagireson S, Thoms BL, Tseu B, Wei R, Yang N, Britton N, Leinhardt D, Mahfooz M, Palkhi A, Price M, Sheikh S, Barker M, Bowley D, Cant M, Datta U, Farooqi M, Lee A, Morley G, Amin MN, Parry A, Patel S, Strang S, Yoganayagam N, Adlan A, Chandramoorthy S, Choudhary Y, Das K, Feldman M, France B, Grace R, Puddy H, Soor P, Ali M, Dhillon P, Faraj A, Gerard L, Glover M, Imran H, Kim S, Patrick Y, Peto J, Prabhudesai A, Smith R, Tang A, Vadgama N, Dhaliwal R, Ecclestone T, Harris A, Ong D, Patel D, Philp C, Stewart E, Wang L, Wong E, Xu Y, Ashaye T, Fozard T, Galloway F, Kaptanis S, Mistry P, Nguyen T, Olagbaiye F, Osman M, Philip Z, Rembacken R, Tayeh S, Theodoropoulou K, Herman A, Lau J, Saha A, Trotter M, Adeleye O, Cave D, Gunwa T, Magalhães J, Makwana S, Mason R, Parish M, Regan H, Renwick P, Roberts G, Salekin D, Sivakumar C, Tariq A, Liew I, McDade A, Stewart D, Hague M, Hudson-Peacock N, Jackson CES, James F, Pitt J, Walker EY, Aftab R, Ang JJ, Anwar S, Battle J, Budd E, Chui J, Crook H, Davies P, 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Patil P, Peck FS, Reza N, Swan I, Whyte M, Chaudhry S, Hernon J, Khawar H, O'Brien J, Pullinger M, Rothnie K, Ujjal S, Bhatte S, Curtis J, Green S, Mayer A, Watkinson G, Chapple K, Hawthorne T, Khaliq M, Majkowski L, Malik TAM, Mclauchlan K, En BNW, Parton S, Robinson SD, Saat MI, Shurovi BN, Varatharasasingam K, Ward AE, Behranwala K, Bertelli M, Cohen J, Duff F, Fafemi O, Gupta R, Manimaran M, Mayhew J, Peprah D, Wong MHY, Farmer N, Houghton C, Kandhari N, Khan K, Ladha D, Mayes J, McLennan F, Panahi P, Seehra H, Agrawal R, Ahmed I, Ali S, Birkinshaw F, Choudhry M, Gokani S, Harrogate S, Jamal S, Nawrozzadeh F, Swaray A, Szczap A, Warusavitarne J, Abdalla M, Asemota N, Cullum R, Hartley M, Maxwell-Armstrong C, Mulvenna C, Phillips J, Yule A, Ahmed L, Clement KD, Craig N, Elseedawy E, Gorman D, Kane L, Livie J, Livie V, Moss E, Naasan A, Ravi F, Shields P, Zhu Y, Archer M, Cobley H, Dennis R, Downes C, Guevel B, Lamptey E, Murray H, Radhakrishnan A, Saravanabavan S, Sardar M, Shaw C, 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P, Tam J, Elias J, Ngaage M, Thompson J, Bristow S, Brock E, Davis H, Pantelidou M, Sathiyakeerthy A, Singh K, Chaudhry A, Dickson G, Glen P, Gregoriou K, Hamid H, Mclean A, Mehtaji P, Neophytou G, Potts S, Belgaid DR, Burke J, Durno J, Ghailan N, Hanson M, Henshaw V, Nazir UR, Omar I, Riley BJ, Roberts J, Smart G, Van Winsen K, Bhatti A, Chan M, D'Auria M, Green S, Keshvala C, Li H, Maxwell-Armstrong C, Michaelidou M, Simmonds L, Smith C, Wimalathasan A, Abbas J, Cairns C, Chin YR, Connelly A, Moug S, Nair A, Svolkinas D, Coe P, Subar D, Wang H, Zaver V, Brayley J, Cookson P, Cunningham L, Gaukroger A, Ho M, Hough A, King J, O'Hagan D, Widdison A, Brown R, Brown B, Chavan A, Francis S, Hare L, Lund J, Malone N, Mavi B, McIlwaine A, Rangarajan S, Abuhussein N, Campbell HS, Daniels J, Fitzgerald I, Mansfield S, Pendrill A, Robertson D, Smart YW, Teng T, Yates J, Belgaumkar A, Katira A, Kossoff J, Kukran S, Laing C, Mathew B, Mohamed T, Myers S, Novell R, Phillips BL, Thomas M, Turlejski T, Turner S, Varcada M, Warren L, Wynell-Mayow W, Church R, Linley-Adams L, Osborn G, Saunders M, Spencer R, Srikanthan M, Tailor S, Tullett A, Ali M, Al-Masri S, Carr G, Ebhogiaye O, Heng S, Manivannan S, Manley J, McMillan LE, Peat C, Phillips B, Thomas S, Whewell H, Williams G, Bienias A, Cope EA, Courquin GR, Day L, Garner C, Gimson A, Harris C, Markham K, Moore T, Nadin T, Phillips C, Subratty SM, Brown K, Dada J, Durbacz M, Filipescu T, Harrison E, Kennedy ED, Khoo E, Kremel D, Lyell I, Pronin S, Tummon R, Ventre C, Walls L, Wootton E, Akhtar A, Davies E, El-Sawy D, Farooq M, Gaddah M, Griffiths H, Katsaiti I, Khadem N, Leong K, Williams I, Chean CS, Chudek D, Desai H, Ellerby N, Hammad A, Malla S, Murphy B, Oshin O, Popova P, Rana S, Ward T, Abbott TEF, Akpenyi O, Edozie F, El Matary R, English W, Jeyabaladevan S, Morgan C, Naidu V, Nicholls K, Peroos S, Prowle J, Sansome S, Torrance HD, Townsend D, Brecher J, Fung H, Kazmi Z, Outlaw P, Pursnani K, Ramanujam N, Razaq A, Sattar M, Sukumar S, Tan TSE, Chohan K, Dhuna S, Haq T, Kirby S, Lacy-Colson J, Logan P, Malik Q, McCann J, Mughal Z, Sadiq S, Sharif I, Shingles C, Simon A, Burnage S, Chan SSN, Craig ARJ, Duffield J, Dutta A, Eastwood M, Iqbal F, Mahmood F, Mahmood W, Patel C, Qadeer A, Robinson A, Rotundo A, Schade A, Slade RD, De Freitas M, Kinnersley H, McDowell E, Moens-Lecumberri S, Ramsden J, Rockall T, Wiffen L, Wright S, Bruce C, Francois V, Hamdan K, Limb C, Lunt AJ, Manley L, Marks M, Phillips CFE, Agnew CJF, Barr CJ, Benons N, Hart SJ, Kandage D, Krysztopik R, Mahalingam P, Mock J, Rajendran S, Stoddart MT, Clements B, Gillespie H, Lee S, McDougall R, Murray C, O'Loane R, Periketi S, Tan S, Amoah R, Bhudia R, Dudley B, Gilbert A, Griffiths B, Khan H, McKigney N, Roberts B, Samuel R, Seelarbokus A, Stubbing-Moore A, Thompson G, Williams P, Ahmed N, Akhtar R, Chandler E, Chappelow I, Gil H, Gower T, Kale A, Lingam G, Rutler L, Sellahewa C, Sheikh A, Stringer H, Taylor R, Aglan H, Ashraf MR, Choo S, Das E, Epstein J, Gentry R, Mills D, Poolovadoo Y, Ward N, Bull K, Cole A, Hack J, Khawari S, Lake C, Mandishona T, Perry R, Sleight S, Sultan S, Thornton T, Williams S, Arif T, Castle A, Chauhan P, Chesner R, Eilon T, Kamarajah S, Kambasha C, Lock L, Loka T, Mohammad F, Motahariasl S, Roper L, Sadhra SS, Sheikh A, Toma T, Wadood Q, Yip J, Ainger E, Busti S, Cunliffe L, Flamini T, Gaffing S, Moorcroft C, Peter M, Simpson L, Stokes E, Stott G, Wilson J, York J, Yousaf A, Borakati A, Brown M, Goaman A, Hodgson B, Ijeomah A, Iroegbu U, Kaur G, Lowe C, Mahmood S, Sattar Z, Sen P, Szuman A, Abbas N, Al-Ausi M, Anto N, Bhome R, Eccles L, Elliott J, Hughes EJ, Jones A, Karunatilleke AS, Knight JS, Manson CCF, Mekhail I, Michaels L, Noton TM, Okenyi E, Reeves T, Yasin IH, Banfield DA, Harris R, Lim D, Mason-Apps C, Roe T, Sandhu J, Shafiq N, Stickler E, Tam JP, Williams LM, Ainsworth P, Boualbanat Y, Doull C, Egan E, Evans L, Hassanin K, Ninkovic-Hall G, Odunlami W, Shergill M, Traish M, Cummings D, Kershaw S, Ong J, Reid F, Toellner H, Alwandi A, Amer M, George D, Haynes K, Hughes K, Peakall L, Premakumar Y, Punjabi N, Ramwell A, Sawkins H, Ashwood J, Baker A, Baron C, Bhide I, Blake E, De Cates C, Esmail R, Hosamuddin H, Kapp J, Nguru N, Raja M, Thomson F, Ahmed H, Aishwarya G, Al-Huneidi R, Ali S, Aziz R, Burke D, Clarke B, Kausar A, Maskill D, Mecia L, Myers L, Smith ACD, Walker G, Wroe N, Donohoe C, Gibbons D, Jordan P, Keogh C, Kiely A, Lalor P, McCrohan M, Powell C, Foley MP, Reynolds J, Silke E, Thorpe O, Kong JTH, White C, Ali Q, Dalrymple J, Ge Y, Khan H, Luo RS, Paine H, Paraskeva B, Parker L, Pillai K, Salciccioli J, Selvadurai S, Sonagara V, Springford LR, Tan L, Appleton S, Leadholm N, Zhang Y, Ahern D, Cotter M, Cremen S, Durrigan T, Flack V, Hrvacic N, Jones H, Jong B, Keane K, O'Connell PR, O'sullivan J, Pek G, Shirazi S, Barker C, Brown A, Carr W, Chen Y, Guillotte C, Harte J, Kokayi A, Lau K, McFarlane S, Morrison S, Broad J, Kenefick N, Makanji D, Printz V, Saito R, Thomas O, Breen H, Kirk S, Kong CH, O'Kane A, Eddama M, Engledow A, Freeman SK, Frost A, Goh C, Lee G, Poonawala R, Suri A, Taribagil P, Brown H, Christie S, Dean S, Gravell R, Haywood E, Holt F, Pilsworth E, Rabiu R, Roscoe HW, Shergill S, Sriram A, Sureshkumar A, Tan LC, Tanna A, Vakharia A, Bhullar S, Brannick S, Dunne E, Frere M, Kerin M, Kumar KM, Pratumsuwan T, Quek R, Salman M, Van Den Berg N, Wong C, Ahluwalia J, Bagga R, Borg CM, Calabria C, Draper A, Farwana M, Joyce H, Khan A, Mazza M, Pankin G, Sait MS, Sandhu N, Virani N, Wong J, Woodhams K, Croghan N, Ghag S, Hogg G, Ismail O, John N, Nadeem K, Naqi M, Noe SM, Sharma A, Tan S, Begum F, Best R, Collishaw A, Glasbey J, Golding D, Gwilym B, Harrison P, Jackman T, Lewis N, Luk YL, Porter T, Potluri S, Stechman M, Tate S, Thomas D, Walford B, Auld F, Bleakley A, Johnston S, Jones C, Khaw J, Milne S, O'Neill S, Singh KKR, Smith R, Swan A, Thorley N, Yalamarthi S, Yin ZD, Ali A, Balian V, Bana R, Clark K, Livesey C, McLachlan G, Mohammad M, Pranesh N, Richards C, Ross F, Sajid M, Brooke M, Francombe J, Gresly J, Hutchinson S, Kerrigan K, Matthews E, Nur S, Parsons L, Sandhu A, Vyas M, White F, Zulkifli A, Zuzarte L, Al-Mousawi A, Arya J, Azam S, Yahaya AA, Gill K, Hallan R, Hathaway C, Leptidis I, McDonagh L, Mitrasinovic S, Mushtaq N, Pang N, Peiris GB, Rinkoff S, Chan L, Christopher E, Farhan-Alanie MMH, Gonzalez-Ciscar A, Graham CJ, Lim H, McLean KA, Paterson HM, Rogers A, Roy C, Rutherford D, Smith F, Zubikarai G, Al-Khudairi R, Bamford M, Chang M, Cheng J, Hedley C, Joseph R, Mitchell B, Perera S, Rothwell L, Siddiqui A, Smith J, Taylor K, Wright OW, Baryan HK, Boyd G, Conchie H, Cox L, Davies J, Gardner S, Hill N, Krishna K, Lakin F, Scotcher S, Alberts J, Asad M, Barraclough J, Campbell A, Marshall D, Wakeford W, Cronbach P, D'Souza F, Gammeri E, Houlton J, Hall M, Kethees A, Patel R, Perera M, Prowle J, Shaid M, Webb E, Beattie S, Chadwick M, El-Taji O, Haddad S, Mann M, Patel M, Popat K, Rimmer L, Riyat H, Smith H, Anandarajah C, Cipparrone M, Desai K, Gao C, Goh ET, Howlader M, Jeffreys N, Karmarkar A, Mathew G, Mukhtar H, Ozcan E, Renukanthan A, Sarens N, Sinha C, Woolley A, Bogle R, Komolafe O, Loo F, Waugh D, Zeng R, Crewe A, Mathias J, Mills A, Owen A, Prior A, Saunders I, Baker A, Crilly L, McKeon J, Ubhi HK, Adeogun A, Carr R, Davison C, Devalia S, Hayat A, Karsan RB, Osborne C, Scott K, Weegenaar C, Wijeyaratne M, Babatunde F, Barnor-Ahiaku E, Beattie G, Chitsabesan P, Dixon O, Hall N, Ilenkovan N, Mackrell T, Nithianandasivam N, Orr J, Palazzo F, Saad M, Sandland-Taylor L, Sherlock J, Ashdown T, Chandler S, Garsaa T, Lloyd J, Loh SY, Ng S, Perkins C, Powell-Chandler A, Smith F, Underhill R. Perioperative intravenous contrast administration and the incidence of acute kidney injury after major gastrointestinal surgery: prospective, multicentre cohort study. Br J Surg 2020; 107:1023-1032. [PMID: 32026470 DOI: 10.1002/bjs.11453] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 09/21/2019] [Accepted: 11/08/2019] [Indexed: 01/14/2023]
Abstract
BACKGROUND This study aimed to determine the impact of preoperative exposure to intravenous contrast for CT and the risk of developing postoperative acute kidney injury (AKI) in patients undergoing major gastrointestinal surgery. METHODS This prospective, multicentre cohort study included adults undergoing gastrointestinal resection, stoma reversal or liver resection. Both elective and emergency procedures were included. Preoperative exposure to intravenous contrast was defined as exposure to contrast administered for the purposes of CT up to 7 days before surgery. The primary endpoint was the rate of AKI within 7 days. Propensity score-matched models were adjusted for patient, disease and operative variables. In a sensitivity analysis, a propensity score-matched model explored the association between preoperative exposure to contrast and AKI in the first 48 h after surgery. RESULTS A total of 5378 patients were included across 173 centres. Overall, 1249 patients (23·2 per cent) received intravenous contrast. The overall rate of AKI within 7 days of surgery was 13·4 per cent (718 of 5378). In the propensity score-matched model, preoperative exposure to contrast was not associated with AKI within 7 days (odds ratio (OR) 0·95, 95 per cent c.i. 0·73 to 1·21; P = 0·669). The sensitivity analysis showed no association between preoperative contrast administration and AKI within 48 h after operation (OR 1·09, 0·84 to 1·41; P = 0·498). CONCLUSION There was no association between preoperative intravenous contrast administered for CT up to 7 days before surgery and postoperative AKI. Risk of contrast-induced nephropathy should not be used as a reason to avoid contrast-enhanced CT.
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Alyaqout K, Lairy A, Efthymiou E, Khwaja H, Warren O, Mills S, Tekkis P, Kontovounisios C. Minimally invasive colorectal cancer procedures in patients with obesity: an interdisciplinary approach. Tech Coloproctol 2019; 23:583-587. [PMID: 31273484 PMCID: PMC6677681 DOI: 10.1007/s10151-019-02027-5] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 06/20/2019] [Indexed: 11/29/2022]
Affiliation(s)
- K Alyaqout
- Department of Bariatric Surgery, Chelsea & Westminster Hospital, London, UK
| | - A Lairy
- Department of Bariatric Surgery, Chelsea & Westminster Hospital, London, UK
| | - E Efthymiou
- Department of Bariatric Surgery, Chelsea & Westminster Hospital, London, UK
| | - H Khwaja
- Department of Bariatric Surgery, Chelsea & Westminster Hospital, London, UK
| | - O Warren
- Department of Colorectal Surgery, Chelsea & Westminster Hospital, London, UK
- Department of Surgery and Cancer, Imperial College London, Chelsea and Westminster and the Royal Marsden Campus, London, UK
| | - S Mills
- Department of Colorectal Surgery, Chelsea & Westminster Hospital, London, UK
- Department of Surgery and Cancer, Imperial College London, Chelsea and Westminster and the Royal Marsden Campus, London, UK
| | - P Tekkis
- Department of Colorectal Surgery, Chelsea & Westminster Hospital, London, UK
- Department of Colorectal Surgery, Royal Marsden Hospital, London, UK
- Department of Surgery and Cancer, Imperial College London, Chelsea and Westminster and the Royal Marsden Campus, London, UK
| | - C Kontovounisios
- Department of Colorectal Surgery, Chelsea & Westminster Hospital, London, UK.
- Department of Colorectal Surgery, Royal Marsden Hospital, London, UK.
- Department of Surgery and Cancer, Imperial College London, Chelsea and Westminster and the Royal Marsden Campus, London, UK.
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Lu A, Adamo M, Warren O. 271EMF Understanding High Utilization of the Emergency Department: An Interview Study. Ann Emerg Med 2018. [DOI: 10.1016/j.annemergmed.2018.08.276] [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: 11/16/2022]
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Oms L, Kalakouti E, Simillis C, Pellino G, Mughal N, Warren O, Mills S, Tan E, Kontovounisios C, Tekkis PP. Surgical Site Infections Related to ESBL Pathogens Post Colon Surgery. Wounds 2018; 30:249-250. [PMID: 30212367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
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Luzietti E, Pellino G, Nikolaou S, Qiu S, Mills S, Warren O, Tekkis P, Kontovounisios C. Comparison of guidelines for the management of rectal cancer. BJS Open 2018; 2:433-451. [PMID: 30511044 PMCID: PMC6254003 DOI: 10.1002/bjs5.88] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 05/18/2018] [Indexed: 12/12/2022] Open
Abstract
A comparison between NCCN, ESMO and JSCCR Guidelines is presented, concerning the treatment of rectal cancer, with an analysis and discussion of their discrepancies. Differences indicate areas for research.
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Affiliation(s)
- E Luzietti
- Department of Surgical Sciences Azienda Ospedaliero - Universitaria di Parma Parma Italy
| | - G Pellino
- Department of Medical, Surgical, Neurological, Metabolic and Ageing Sciences Universtià della Campania 'Luigi Vanvitelli' Naples Italy.,Department of Colorectal Surgery Royal Marsden Hospital London UK
| | - S Nikolaou
- Department of Colorectal Surgery Royal Marsden Hospital London UK
| | - S Qiu
- Department of Surgery and Cancer Imperial College London London UK.,Department of Colorectal Surgery Chelsea and Westminster Hospital London UK
| | - S Mills
- Department of Colorectal Surgery Chelsea and Westminster Hospital London UK
| | - O Warren
- Department of Colorectal Surgery Chelsea and Westminster Hospital London UK
| | - P Tekkis
- Department of Colorectal Surgery Royal Marsden Hospital London UK.,Department of Surgery and Cancer Imperial College London London UK.,Department of Colorectal Surgery Chelsea and Westminster Hospital London UK
| | - C Kontovounisios
- Department of Surgery and Cancer Imperial College London London UK.,Department of Colorectal Surgery Chelsea and Westminster Hospital London UK
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Bhangu A, Ademuyiwa AO, Aguilera ML, Alexander P, Al-Saqqa SW, Borda-Luque G, Costas-Chavarri A, Drake TM, Ntirenganya F, Fitzgerald JE, Fergusson SJ, Glasbey J, Ingabire JCA, Ismaïl L, Salem HK, Kojo ATT, Lapitan MC, Lilford R, Mihaljevic AL, Morton D, Mutabazi AZ, Nepogodiev D, Adisa AO, Ots R, Pata F, Pinkney T, Poškus T, Qureshi AU, Ramos-De la Medina A, Rayne S, Shaw CA, Shu S, Spence R, Smart N, Tabiri S, Harrison EM, Khatri C, Mohan M, Jaffry Z, Altamini A, Kirby A, Søreide K, Recinos G, Cornick J, Modolo MM, Iyer D, King S, Arthur T, Nahar SN, Waterman A, Walsh M, Agarwal A, Zani A, Firdouse M, Rouse T, Liu Q, Correa JC, Talving P, Worku M, Arnaud A, Kalles V, Kumar B, Kumar S, Amandito R, Quek R, Ansaloni L, Altibi A, Venskutonis D, Zilinskas J, Poskus T, Whitaker J, Msosa V, Tew YY, Farrugia A, Borg E, Bentounsi Z, Gala T, Al-Slaibi I, Tahboub H, Alser OH, Romani D, Shu S, Major P, Mironescu A, Bratu M, Kourdouli A, Ndajiwo A, Altwijri A, Alsaggaf MU, Gudal A, Jubran AF, Seisay S, Lieske B, Ortega I, Jeyakumar J, Senanayake KJ, Abdulbagi O, Cengiz Y, Raptis D, Altinel Y, Kong C, Teasdale E, Irwin G, Stoddart M, Kabariti R, Suresh S, Gash K, Narayanan R, Maimbo M, Grizhja B, Ymeri S, Galiqi G, Klappenbach R, Antezana D, Mendoza Beleño AE, Costa C, Sanchez B, Aviles S, Fermani CG, Balmaceda R, Villalobos S, Carmona JM, Hamill D, Deutschmann P, Sandler S, Cox D, Nataraja R, Sharpin C, Ljuhar D, Gray D, Haines M, Iyer D, Niranjan N, D'Amours S, Ashtari M, Franco H, Rahman Mitul A, Karim S, Aman NF, Estee MM, Salma U, Razzaque J, Hamid Kanta T, Tori SA, Alamin S, Roy S, Al Amin S, Karim R, Haque M, Faruq A, Iftekhar F, O'Shea M, Padmore G, Jonnalagadda R, Litvin A, Filatau A, Paulouski D, Shubianok M, Shachykava T, Khokha D, Khokha V, Djivoh F, Dossou F, Seto DM, Gbessi DG, Noukpozounkou B, Imorou Souaibou Y, Keke KR, Hodonou F, Ahounou EYS, Alihonou T, Dénakpo M, Ahlonsou G, Ginbo Bedada A, Nsengiyumva C, Kwizera S, Barendegere V, Choi P, Stock S, Jamal L, Azzie G, Kushwaha S, Chen TL, Yip C, Montes I, Zapata F, Sierra S, Villegas Lanau MI, Mendoza Arango MC, Mendoza Restrepo I, Restrepo Giraldo RS, Domini E, Karlo R, Mihanovic J, Youssef M, Elfeki H, Thabet W, Sanad A, Tawfik G, Zaki A, Abdel-Hameed N, Mostafa M, Omar MFW, Ghanem A, Abdallah E, Denewer A, Emara E, Rashad E, Sakr A, Elashry R, Emile S, Khafagy T, Elhamouly S, Elfarargy A, Mamdouh Mohamed A, Saied Nagy G, Esam A, Elwy E, Hammad A, Khallaf S, Ibrahim E, Said Badr A, Moustafa A, Eldosouky Mohammed A, Elgheriany M, Abdelmageed E, Al Raouf EA, Samir Elbanby E, Elmasry M, Morsy Farahat M, Yahya Mansor E, Magdy Hegazy E, Gamal E, Gamal H, Kandil H, Maher Abdelrouf D, Moaty M, Gamal D, El-Sagheer N, Salah M, Magdy S, Salah A, Essam A, Ali A, Badawy M, Ahmed S, Mohamed M, Assal A, Sleem M, Ebidy M, Abd-Elrazek A, Zahran D, Adam N, Nazir M, Hassanein AB, Ismail A, Elsawy A, Mamdouh R, Mabrouk M, Ahmed LAM, Hassab Alnaby M, Magdy E, Abd-Elmawla M, Fahim M, Mowafy B, Ibrahim Mahmoud M, Allam M, Alkelani M, Halim El Gendy N, Saad Aboul-Naga M, Alaa El-Din R, Elgendy AH, Ismail M, Shalaby M, Adel Elsharkawy A, Elsayed Moghazy M, Hesham Elbisomy K, Abdel Gawad Shakshouk H, Hamed MF, Ebidy MM, Abdelkader M, Karkeet M, Ahmed H, Adel I, Omar ME, Ibrahim M, Ghoneim O, Hesham O, Gamal S, Hilal K, Arafa O, Adel Awad S, Salem M, Abdellatif Elsherif F, Elsabbagh N, Aboelsoud MR, Hossam Eldin Fouad Rida A, Hossameldin A, Hany E, Hosny Asar Y, Anwar N, Gadelkarim M, Abdelhady S, Mohamed Morshedy E, Saad R, Soliman N, Salama M, Ezzat E, Mohamed A, Ibrahim A, Fergany A, Mohammed S, Reda A, Allam Y, Saad HA, Abdelfatah A, Fathy AM, El-Sehily A, Abdalmageed Kasem E, Hassan ATA, Mohammed AR, Saad AG, Elfouly Y, Elfouly N, Ibrahim A, Hassaan A, Mohammed MM, Elhoseny G, Magdy M, Abd Elkhalek E, Zakaria Y, Ezzat T, Abo El Dahab A, Kelany M, Arafa S, Mokhtar Mohamed Hassan O, Mohamed Badwi N, Saber Sleem A, Ahmed H, Abdelbadeai K, Abozed Abdullah M, Lokman MAA, Bahar S, Rady Abdelazeam A, Adelshone A, Bin Hasnan M, Zulkifli A, Kamarulzamil SNA, Elhendawy A, Latif A, Bin Adnan A, Shaharuddin S, Haji Abdul Majid AH, Amreia M, Al-Marakby D, Salma M, Ismail MJB, Mohd Basir ER, Mohd Ali CD, Ata AY, Nasr M, Rezq A, Sheta A, Tariq S, Sallam AE, Darwish AKZ, Elmihy S, Elhadry S, Farag A, Hajeh H, Abdelaal A, Aglan A, Zohair A, Essam M, Moussa O, El-Gizawy E, Samy M, Ali S, El Halawany E, Ata A, El Halawany M, Nashat M, Soliman S, Elazab A, Samy M, Abdelaziz MA, Ibrahim K, Ibrahim AM, Gado A, Hantour U, Alm Eldeen E, Loaloa MR, Abouzaid A, Ahmed Bahaa Eldin M, Hashad E, Sroor F, Gamil D, Mahmoud Abdulhakeem E, Zakaria M, Mohamed F, Abubakr M, Ali E, Magdy H, Ramadan MT, Abdelaty Mohamed M, Mansour S, Abdul Aziz Amin H, Rabie Mohamed A, Saami M, Ahmed Reda Elsayed N, Tarek A, Mohy Eldeen Mahmoud S, Magdy El Sayed I, Reda A, Yusuf Shawky M, Mousa Salem M, Alaa El-Din S, Abdullah Soliman N, Talaat M, Alaael-Dein S, Abd Elmoen Elhusseiny A, Abdullah N, Elshaar M, Abdelfatah 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A, Al Barrawi FE, Alkhatib A, Al-Faqawi M, Fares M, Elmashala A, Adawi M, Adawi I, Khreishi R, Khreishi R, Ashour A, Ghaben A, Machain Vega GM, Cardozo JT, Roche MO, Pertersen Servin GR, Segovia Lohse HA, Páez Lopez LI, Cardozo RAM, Espinoza F, Pérez Rojas AD, Sanchez D, Samaniego CS, Guevara Torres S, Calua AC, Razuri C, Ortiz N, Rodriguez X, Carrasco N, Saravia F, Shibao Miyasato H, Valcarcel-Saldaña M, Bermúdez YEA, Carpio J, Ruiz Panez W, Toribio Orbegozo PA, Guzmán Dueñas C, Turpo Espinoza K, Sandoval Barrantes AM, Chungui Bravo JA, Fuentes-Rivera L, Fernández C, Málaga B, Ye J, Velasquez R, Salcedo J, Contreras-Vergara AL, Vergara Mejia AG, Gonzales Montejo MS, Escalante Salas MDC, Alcca Ticona W, Vargas M, Manrique Sila GC, Mas R, del Pilar Paucar A, Román Velásquez AJ, Robledo-Rabanal A, Solis LAZ, Turpo Espinoza K, Hamasaki Hamaguchi JL, Florez Farfan ES, Madrid Barrientos LA, Herrera Matta JJ, Mora JJV, Redota MAP, Roxas MF, Maño MJB, Parreno-Sacdalan MD, Almanon CL, 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Bougard H, Noor F, Dell A, Van Straten S, Khamajeet A, Tshisola SK, Kabongo K, Kong V, Moodley Y, Anderson F, Madiba T, du Plooy F, Hartford L, Chilton G, Karjiker P, Mabitsela ME, Ndlovu SR, Badicel M, Jaich R, Ruiz-Tovar J, Garcia-Florez L, Otero-Díez JL, Ramos Pérez V, Aguado Suárez N, Minguez García J, Corral Moreno S, Collado MV, Jiménez Carneros V, García Septiem J, Gonzalez M, Picardo A, Esteban E, Ferrero E, Espin-Basany E, Blanco-Colino R, Andriola V, Solar García L, Contreras E, García Bernardo C, Pagnozzi J, Sanz S, Miyar de León A, Dorismé A, Rodicio J, Suarez A, Stuva J, Diaz Vico T, Fernandez-Vega L, Soldevila-Verdeguer C, Sena-Ruiz F, Pujol-Cano N, Diaz-Jover P, Garcia-Perez JM, Segura-Sampedro JJ, Pineño-Flores C, Ambrona-Zafra D, Craus-Miguel A, Jimenez-Morillas P, Mazzella A, Jayathilake AB, Thalgaspitiya SPB, Wijayarathna LS, Wimalge PMSN, Sanni HA, Okenabirhie O, Homeida A, Younis A, Omer OA, Abdulaziz M, Mussad A, Adam A, Björklund I, Ahlqvist S, Thorell A, Wogensen F, Sokratous A, Breistrand M, Thorarinsdottir H, Sigurdadottir J, Nikberg M, Chabok A, Hjertberg M, Elbe P, Saraste D, Rutkowski W, Forlin L, Niska K, Sund M, Oswald D, Peros G, Bluelle R, Reinisch K, Frey D, Palma A, Raptis DA, Zumbühl L, Zuber M, Schmid R, Werder G, Nocito A, Gerosa A, Mahanty S, Widmer LW, Müller J, Gübeli A, Zuk G, Gulcicek OB, Vartanoglu T, Kose E, Karahan SR, Aydin MC, Sahbaz NA, Halicioglu I, Alis H, Sapci I, Adiyaman C, Pektaş AM, Cengiz TB, Tansoker I, Işler V, Cevik M, Mutlu D, Ozben V, Ozmen BB, Bayram S, Yolcu S, Kobal BB, Toto ÖF, Çakaloğlu HC, Karabulut K, Mutlu V, Ozkan BB, Celik S, Semiz A, Bodur S, Gül E, Murutoglu B, Yildirim R, Baki BE, Arslan E, Ulusahin M, Guner A, Tomas K, Walker N, Shrimanker N, Cole S, Breslin R, Srinivasan R, Elshaer M, Hunter K, Al-Bahrani A, Liew I, Mairs NG, Rocke A, Dick L, Qureshi M, Chowdhury D, Wright N, Skerritt C, Kufeji D, Ho A, Dissanayake T, Tennakoon A, Ali W, Lim SJ, Tan C, O'Neill S, Jones C, Knight S, Nassif D, Sharma A, Warren O, White R, Mehdi A, Post N, Kalakouti E, Dashnyam E, Stourton F, Mykoniatis I, Currow C, Wong F, Gupta A, Shatkar V, Luck J, Kadiwar S, Smedley A, Wakefield R, Herrod P, Blackwell J, Lund J, Cohen F, Bandi A, Giuliani S, Bond-Smith G, Pezas T, Farhangmehr N, Urbonas T, Perenyei M, Ireland P, Blencowe N, Bowling K, Bunting D, Longstaff L, Keogh K, Jeon H, Iqbal MR, Khosla S, Jeffery A, Perera J, Ibrahem AA, Alhammali T, Salama Y, Oram S, Kidd T, Cullen F, Owen C, Wilson M, Chiu S, Sarafilovic H, Ploski J, Evans E, Abbas A, Kamya S, Ishak N, Bisset C, Andress C, Chin YR, Patel P, Evans D, Haslegrave A, Boggon A, Laurie K, Connor K, Mann T, Mansuri A, Davies R, Griffiths E, Shahbaz AR, Eng C, Din F, L'Heveder A, Park EHG, Ravishankar R, McIntosh K, Yau JD, Chan L, McGarvie S, Tang L, Lim H, Yap S, Park J, Ng ZH, Mirza S, Ang YL, Walls L, Roy C, Paterson-Brown S, Camilleri-Brennan J, Mclean K, D'Souza MS, Pronin S, Henshall DE, Ter EZ, Fouad D, Minocha A, English W, Morgan C, Townsend D, Maciejec L, Mahdi S, Akpenyi O, Hall E, Caydiid H, Rob Z, Abbott T, Torrance HD, Johnston R, Gani MA, Gravante G, Rajmohan S, Majid K, Dindyal S, Smith C, Palliyil M, Patel S, Nicholson L, Harvey N, Baillie K, Shillito S, Kershaw S, Bamford R, Orton P, Reunis E, Tyler R, Soon WC, Jama GM, Dhillon D, Patel K, Nanthakumaran S, Heard R, Chen KY, Barmayehvar B, Datta U, Kamarajah SK, Karandikar S, Iftekhar Tani S, Monaghan E, Donnelly P, Walker M, Parakh J, Blacker S, Kaul A, Paramasivan A, Farag S, Nessa A, Awadallah S, Lim J, Chean Khun Ng J, Kiran RP, Murray A, Etchill E, Dasari M, Puyana J, Haddad N, Zielinski M, Choudhry A, Caliman C, Beamon M, Duane T, Swaroop M, Myers J, Deal R, Schadde E, Hemmila M, Napolitano L, To K, Makupe A, Musowoya J, van der Naald N, Kumwenda D, Reece-Smith A, Otten K, Verbeek A, Prins M, Baquero Suarez AA, Balmaceda R, Deane C, Dijan E, Elfiky M, Koskenvuo L, Thollot A, Limoges B, Capito C, Alexandre C, Kotobi H, Leroux J, Pinnagoda K, Henric N, Azzis O, Rosello O, Francois P, Etienne S, Buisson P, Hmila S, Clegg-Lamptey JN, Imoro O, Abem OE, Papageorgiou D, Soulou V, Asturias S, Peña L, O'Connor DB, Luc AR, Russo AA, Ruzzenente A, Taddei A, Cona C, Bottini C, Pascale G, Rotunno G, Solaini L, Pascale MM, Notarnicola M, Corbellino M, Sacco M, Ubiali P, Cautiero R, Bocchetti T, Muzio E, Guglielmo V, Morandi E, Mao P, de Luca E, Ali FM, Žilinskas J, Strupas K, Kondrotas P, Baltrunas R, Kutkevicius J, Ignatavicius P, Tan CL, Siaw JY, Yam SY, Wilson L, Aziz MRA, Bondin J, Zorrilla CD, Majbar A, Sale D, Abdullahi L, Osagie O, Faboya O, Fatuga A, Taiwo A, Nwabuoku E, Bliksøen M, Khan ZA, Coronel J, Miranda C, Vasquez I, Helguero-Santin LM, Rickard J, Adedeji A, Alqahtani S, Rath M, Van Niekerk M, Koto MZ, Matos-Puig R, Israelsson L, Schuetz T, Yuksek MA, Mericliler M, Ulusahin M, Wolf B, Fairfield C, Yong GL, Whitehurst K, Redgrave N, Musyoka CK, Olivier J, Lee K, Cox M, Farhan-Alanie MMH, Callan R, Chibuye C, Ali THA, Rekhis S, Rommaneh M, Sam ZH, Pugliesi TB, Pardo G, Blanco R. Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study. Lancet Infect Dis 2018; 18:516-525. [PMID: 29452941 PMCID: PMC5910057 DOI: 10.1016/s1473-3099(18)30101-4] [Citation(s) in RCA: 236] [Impact Index Per Article: 39.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Revised: 12/06/2017] [Accepted: 12/15/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. METHODS This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. FINDINGS Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p<0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05-2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p<0·001). INTERPRETATION Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication. FUNDING DFID-MRC-Wellcome Trust Joint Global Health Trial Development Grant, National Institute of Health Research Global Health Research Unit Grant.
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Kalakouti E, Simillis C, Pellino G, Mughal N, Warren O, Mills S, Tan E, Kontovounisios C, Tekkis PP. Characteristics of Surgical Site Infection Following Colorectal Surgery in a Tertiary Center: Extended-spectrum β-Lactamase-producing Bacteria Culprits in Disease. Wounds 2017; 30:108-113. [PMID: 29718820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
INTRODUCTION Surgical site infection (SSI) is a well-known complication of colorectal surgery associated with increased morbidity and hospital stay. Antimicrobial prophylaxis can reduce the risk of SSI by as much as 75%. Extended-spectrum β-lactamase (ESBL)-producing pathogens make the successful use of such prophylaxis a challenge and are a real threat to patient care following colorectal surgery. OBJECTIVE The aim of this study is to report the common characteristics of SSIs after colorectal surgery and to highlight the prevalence, risk factors, and clinical relevance of ESBL infections among these patients in a tertiary center. MATERIALS AND METHODS All patients who underwent bowel resection operation (ie, laparoscopy, laparotomy, or laparoscopic-assisted colectomy) for benign or malignant colorectal disease were identified retrospectively from the prospective database of the colorectal department in the authors' tertiary center from March 2015 to March 2016. RESULTS There were 123 patients included in this study, of which 21% (n = 26) had a SSI. The microorganisms isolated in the surgical sites included Escherichia coli, Pseudomonas aeruginosa, Klebsiella pneumoniae, methicillin-resistant Staphylococcus aureus, Proteus mirabilis, Morganella morganii, and Enterobacter cloacae. Thirty-eight percent of the wound infections grew ESBL-producing pathogens in their wound cultures and 62% grew non-ESBL microbes. CONCLUSIONS More than one-third of the wound infections were due to ESBL-producing pathogens, which were resistant to the antibiotic prophylaxis given. Inappropriate antibiotic usage can delay postoperative recovery. High-risk patients for ESBL colonization may benefit from preoperative screening based on an established protocol. The cost effectiveness of an ESBL screening program needs to be further studied.
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Affiliation(s)
- Eliana Kalakouti
- Department of Colorectal Surgery, Chelsea and Westminster Hospital, London, UK
| | | | | | - Nabeela Mughal
- Department of Colorectal Surgery, Chelsea and Westminster Hospital, London, UK
| | - Oliver Warren
- Department of Colorectal Surgery, Chelsea and Westminster Hospital, London, UK
| | - Sarah Mills
- Department of Colorectal Surgery, Chelsea and Westminster Hospital, London, UK
| | - Emile Tan
- Department of Colorectal Surgery, Chelsea and Westminster Hospital, London, UK
| | - Christos Kontovounisios
- Department of Colorectal Surgery, Chelsea and Westminster Hospital, London, UK; and The Royal Marsden NHS Foundation Trust, London, UK
| | - Paris P Tekkis
- Department of Colorectal Surgery, Chelsea and Westminster Hospital, London, UK; and The Royal Marsden NHS Foundation Trust, London, UK
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Yen C, Simillis C, Choudhry M, Mills S, Warren O, Tekkis PP, Kontovounisios C. A comparative study of short-term outcomes of colorectal cancer surgery in the elderly population. Acta Chir Belg 2017; 117:303-307. [PMID: 28490285 DOI: 10.1080/00015458.2017.1321269] [Citation(s) in RCA: 7] [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] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Colorectal Cancer (CRC) is a disease of the elderly, and with an ageing population, oncological surgical procedures for CRC in the elderly is expected to increase. However, the balance between surgical benefits and risks associated with age and comorbidities in elderly patients is obscure. MATERIALS AND METHODS A retrospective database of consecutive patients who received CRC surgery was used to compare short-term surgical and oncological outcomes between patients aged ≥75 and <75 years old undergoing CRC resection. RESULTS There were 54 patients (63.5%) in the <75 group and 31 patients (36.5%) in the ≥75 group. Overall, there were no differences between the <75 and ≥75 groups in postoperative HDU/ITU stay, median hospital LOS or 30-day mortality rates. Patients ≥75 had a higher preoperative performance status (25.9% versus 71.0%, p < .001), but no difference in ASA Grade and referral pattern, proportion of emergency operations, cancer staging, resection margins, achievement of curative resection or median lymph node yield. There was a significantly higher use of adjuvant chemotherapy in the <75 age group (48.1% versus 25.8%, p = .043). CONCLUSIONS With adequate patient selection, CRC resection in elderly patients is not associated with higher postoperative mortality or worse short-term oncological benefits.
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Affiliation(s)
- Clarence Yen
- Department of Surgery and Cancer, Chelsea and Westminster Hospital, Imperial College London NHS Trust, London, UK
| | - Constantinos Simillis
- Department of Surgery and Cancer, Chelsea and Westminster Hospital, Imperial College London NHS Trust, London, UK
- Department of Colorectal Surgery, The Royal Marsden NHS Foundation Trust, London, UK
| | - Mariam Choudhry
- Department of Surgery and Cancer, Chelsea and Westminster Hospital, Imperial College London NHS Trust, London, UK
| | - Sarah Mills
- Department of Surgery and Cancer, Chelsea and Westminster Hospital, Imperial College London NHS Trust, London, UK
| | - Oliver Warren
- Department of Surgery and Cancer, Chelsea and Westminster Hospital, Imperial College London NHS Trust, London, UK
| | - Paris P. Tekkis
- Department of Surgery and Cancer, Chelsea and Westminster Hospital, Imperial College London NHS Trust, London, UK
- Department of Colorectal Surgery, The Royal Marsden NHS Foundation Trust, London, UK
| | - Christos Kontovounisios
- Department of Surgery and Cancer, Chelsea and Westminster Hospital, Imperial College London NHS Trust, London, UK
- Department of Colorectal Surgery, The Royal Marsden NHS Foundation Trust, London, UK
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Pellino G, Simillis C, Qiu S, Rasheed S, Mills S, Warren O, Kontovounisios C, Tekkis PP. Social media and colorectal cancer: A systematic review of available resources. PLoS One 2017; 12:e0183031. [PMID: 28832603 PMCID: PMC5568334 DOI: 10.1371/journal.pone.0183031] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Accepted: 07/29/2017] [Indexed: 01/01/2023] Open
Abstract
AIM Social media (SM) can provide information and medical knowledge to patients. Our aim was to review the literature and web-based content on SM that is used by Colorectal Cancer (CRC) patients, as well as surgeons' interaction with SM. METHOD Studies published between 2006 and 2016 were assessed. We also assessed the impact of several hashtags on Twitter with a freeware (Symplur). RESULTS Nine studies were included assessing Twitter (78%), Forums/Cancer-survivor networks (33%), and Facebook (22%). Aims included use of SM by CRC patients (67%), cancer-specific usage of SM with different types of cancer (44%), content credibility (33%), and influence in CRC awareness (33%). Prevention was the most common information that CRC patients looked for, followed by treatment side-effects. Only 2% of CRC SM users are doctors. SM use by colorectal consultants was suboptimal. Only 38% of surgeons had a LinkedIn account (most with less than 50 connections), and 3% used Twitter. A steep increase of tweets was observed for searched Hashtags over time, which was more marked for #ColonCancer (+67%vs+38%, #Coloncancer vs #RectalCancer). Participants engaged with colon cancer increased by 85%, whereas rectal cancer ones increased by 29%. The hashtag '#RectalCancer' was mostly tweeted by colorectal surgeons. The official twitter account of American Society of Colorectal Surgeons (@fascrs_updates) was the most active account. CONCLUSION CRC patients and relatives are increasingly engaging with SM. CRC surgeons' participation is poor, but we confirm a trend toward a greater involvement. Most SM lack of authoritative validation and the quality of shared content still is largely anecdotic and not scientifically evidenced-based. However, SM may offer several advantages over conventional information sharing sources for CRC patients and surgeons, and create connections with mutual enrichment.
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Affiliation(s)
- Gianluca Pellino
- Department of Colorectal Surgery, Royal Marsden Hospital, London, United Kingdom
| | | | - Shengyang Qiu
- Department of Colorectal Surgery, Royal Marsden Hospital, London, United Kingdom
| | - Shahnawaz Rasheed
- Department of Colorectal Surgery, Royal Marsden Hospital, London, United Kingdom
- Department of Colorectal Surgery, Chelsea and Westminster Hospital, London, United Kingdom
- Department of Surgery and Cancer, Imperial College, London, United Kingdom
| | - Sarah Mills
- Department of Colorectal Surgery, Chelsea and Westminster Hospital, London, United Kingdom
| | - Oliver Warren
- Department of Colorectal Surgery, Chelsea and Westminster Hospital, London, United Kingdom
| | - Christos Kontovounisios
- Department of Colorectal Surgery, Royal Marsden Hospital, London, United Kingdom
- Department of Colorectal Surgery, Chelsea and Westminster Hospital, London, United Kingdom
- Department of Surgery and Cancer, Imperial College, London, United Kingdom
- * E-mail:
| | - Paris P. Tekkis
- Department of Colorectal Surgery, Royal Marsden Hospital, London, United Kingdom
- Department of Colorectal Surgery, Chelsea and Westminster Hospital, London, United Kingdom
- Department of Surgery and Cancer, Imperial College, London, United Kingdom
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Boardman FK, Young PJ, Warren O, Griffiths FE. The role of experiential knowledge within attitudes towards genetic carrier screening: A comparison of people with and without experience of spinal muscular atrophy. Health Expect 2017; 21:201-211. [PMID: 28703871 PMCID: PMC5750730 DOI: 10.1111/hex.12602] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [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] [Accepted: 06/16/2017] [Indexed: 01/11/2023] Open
Abstract
Purpose Autosomal recessive conditions, while individually rare, are a significant health burden with limited treatment options. Population carrier screening has been suggested as a means of tackling them. Little is known, however, about the attitudes of the general public towards such carrier screening and still less about the views of people living with candidate genetic diseases. Here, we focus on the role that such experience has on screening attitudes by comparing views towards screening of people with and without prior experience of the monogenetic disorder, Spinal Muscular Atrophy. Methods An exploratory sequential mixed methods design was adopted. In‐depth qualitative interviews were used to develop two surveys. The surveys addressed attitudes towards carrier screening (pre‐conceptual and prenatal) for SMA. Participants 337 participants with SMA experience completed the SMA Screening Survey (UK) and 336 participants with no prior experience of SMA completed the UK GenPop Survey, an amended version of the SMA Screening Survey (UK). Results The majority of both cohorts were in favour of pre‐conception and prenatal carrier screening, however people with experience of type II SMA were least likely to support either. Key differences emerged around perceptions of SMA, with those without SMA experience taking a dimmer view of the condition than those with. Conclusion This study underscores the significance of prior experience with the condition to screening attitudes. It highlights the need for accurate and high‐quality educational resources to support any future carrier screening programmes, that particularly in relation to rare genetic disorders like SMA that will fall outside the remit of everyday experience for the majority of the population.
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Affiliation(s)
- Felicity K Boardman
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Philip J Young
- School of Life Sciences, University of Warwick, Coventry, UK
| | - Oliver Warren
- School of Life Sciences, University of Warwick, Coventry, UK
| | - Frances E Griffiths
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
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Pellino G, Simillis C, Kontovounisios C, Baird DL, Nikolaou S, Warren O, Tekkis PP, Rasheed S. Colorectal cancer diagnosed during pregnancy: systematic review and treatment pathways. Eur J Gastroenterol Hepatol 2017; 29:743-753. [PMID: 28252463 DOI: 10.1097/meg.0000000000000863] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The aim of this study was to identify the mode of presentation and incidence of colorectal cancer in pregnancy (CRC-p), assess the outcomes of the mother and foetus according to gestational age, treatment delivered and cancer features and location. A systematic review of the literature was carried out to identify studies reporting on CRC-p and pooled analysis of the reported data. Seventy-nine papers reporting on 119 patients with unequivocal CRC-p were included. The calculated pooled risk is 0.002% and age at diagnosis has decreased over time. The median age at diagnosis was 32 (range, 17-46) years. Twelve per cent, 41 and 47% of CRC-p were diagnosed during the first, second and third trimester. The CRC-p site was the colon in 53.4% of cases, the rectum in 44% and multiple sites in 2.6%. Bleeding occurred in 47% of patients, abdominal pain in 37.6%, constipation in 14.1%, obstruction in 9.4% and perforation in 2.4%. Out of 82 patients whose treatment was described, 9.8% received chemotherapy during pregnancy. None of their newborns developed permanent disability, one developed hypothyroidism and 72% of newborns were alive. Vaginal delivery was possible in 60% of cases. Anterior resection was performed in 30% of patients and abdominoperineal excision of the rectum in 14.9%. Five patients had either synchronous (60%) or metachronous liver resection (40%). The median survival in these patients was 42 (0-120) months. Fifty-five per cent of patients were alive at the last available follow-up. The median survival of the mother was 36 (0-360) months. Patients with rectal cancer had longer survival compared with patients with colon cancer (P=0.0072). CRC-p is rare, leading to symptoms being overlooked, and diagnosis made at advanced stages. Cases described in the literature include patients who had cancer before pregnancy or developed it after delivery. Survival has not increased over time and the management of these patients requires collaboration between specialties and active interaction with the patients.
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Affiliation(s)
- Gianluca Pellino
- aDepartment of Colorectal Surgery, Royal Marsden Hospital bDepartment of Colorectal Surgery, Chelsea and Westminster Hospital cDepartment of Surgery and Cancer, Imperial College, London, UK
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Pellino G, Ramage L, Simillis C, Warren O, Kontovounisios C, Tan E, Tekkis P. Evaluation of sexual dysfunction in female patients presenting with faecal incontinence or defecation disorder. Int J Colorectal Dis 2017; 32:667-674. [PMID: 28299421 DOI: 10.1007/s00384-017-2795-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [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] [Accepted: 03/03/2017] [Indexed: 02/04/2023]
Abstract
PURPOSE Female patients with pelvic floor diseases may suffer from several sexual disorders and sexual life impairments. The aim of this manuscript was to evaluate sexual dysfunction in female patients presenting with faecal incontinence (FI) and defecation disorder (DD). METHODS A retrospective review was performed of a prospectively collected database of sexually active women referred to the pelvic floor clinic, who completed the Pelvic Organ Prolapse/Incontinence Sexual Questionnaire-12 (PISQ-12) at first visit. Statistical analysis was performed to evaluate and compare sexual dysfunction between patients with FI and DD and with published data on the general population. Regression analysis was used to identify predictors of sexual dysfunction and surgery. RESULTS Three hundred thirteen patients were included, 192 (61%) with FI and 121 (39%) with DD. The patients with DD received more non-gynaecological surgical procedures (p = 0.023). More patients with DD received surgery for their current pelvic floor disease (p < 0.001). Major sexual impairment (PISQ-12 < 30) was found in 100 patients (31.9%). The mean PISQ-12 (33.2 ± 7.2) score was by 5 points lower than those reported in the general population from PISQ-validating studies. Prior anorectal surgery (odds ratio (OR) = 15.4), partner ejaculation problems (PISQ item 11, OR = 2.5), reduced sexual arousal (item 2, OR = 2.1), and orgasm perception (item 13, OR = 2.1) were the strongest predictors of worse sexual function in patients with FI. Patients with DD were almost 15 times more likely to receive subsequent surgery (OR = 14.6, p < 0.001), whereas fear of urine leakage almost doubled the risk. CONCLUSIONS Sexual dysfunction is prevalent among patients suffering from FI and DD, and questionnaires are useful in recognizing these patients. Subsequent surgery is more common for patients with DD compared to those with FI.
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Affiliation(s)
- Gianluca Pellino
- Department of Surgery and Cancer, Chelsea and Westminster Hospital, Imperial College London, London, UK
| | - Lisa Ramage
- Department of Surgery and Cancer, Chelsea and Westminster Hospital, Imperial College London, London, UK
| | - Constantinos Simillis
- Department of Surgery and Cancer, Chelsea and Westminster Hospital, Imperial College London, London, UK
| | - Oliver Warren
- Department of Surgery and Cancer, Chelsea and Westminster Hospital, Imperial College London, London, UK
| | - Christos Kontovounisios
- Department of Surgery and Cancer, Chelsea and Westminster Hospital, Imperial College London, London, UK. .,Academic Surgery, 3rd Floor, Chelsea and Westminster Hospital, Imperial College London, Fulham Road, London, SW3 6JJ, UK.
| | - Emile Tan
- Department of Surgery and Cancer, Chelsea and Westminster Hospital, Imperial College London, London, UK.,Department of Colorectal Surgery, Singapore General Hospital, Singapore, Republic of Singapore
| | - Paris Tekkis
- Department of Surgery and Cancer, Chelsea and Westminster Hospital, Imperial College London, London, UK
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Browning D, Warren O, Johnson N, Seymour M, Lawson M, Jones L, Kerr A, White R, Mills S. Telephone assessment clinic (TAC): A more efficient way of dealing with two week wait colorectal cancer referrals. Int J Surg 2016. [DOI: 10.1016/j.ijsu.2016.08.168] [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: 10/20/2022]
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Roland D, Warren O, Klaber RE. Engaging with leadership learning in the workplace. Lancet 2012; 380:563. [PMID: 22883505 DOI: 10.1016/s0140-6736(12)61328-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Warren O, Stanton E. Leadership: Seven habits of emerging medical leaders. Health Serv J 2012; 122:28-30. [PMID: 22568297] [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] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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Patel VM, Warren O, Ahmed K, Humphris P, Abbasi S, Ashrafian H, Darzi A, Athanasiou T. How can we build mentorship in surgeons of the future? ANZ J Surg 2011; 81:418-24. [DOI: 10.1111/j.1445-2197.2011.05779.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Hodgkinson J, Shukur Z, Tan E, Warren O, Iqbal Q, Harris S, Mohsen Y, Prabhudesai A. Are C-reactive protein levels necessary in the diagnosis of acute appendicitis in children? Int J Surg 2011. [DOI: 10.1016/j.ijsu.2011.07.210] [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: 10/17/2022]
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Shukur Z, Hodgkinson J, Tan E, Warren O, Iqbal K, Harris S, Mohsen Y, Prabhudesai A. Are C-reactive protein levels necessary to diagnose acute appendicitis in adults? Int J Surg 2011. [DOI: 10.1016/j.ijsu.2011.07.263] [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: 10/17/2022]
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Butrous E, Park C, Warren O. Improving medical management and leadership development in undergraduates. Med Teach 2011; 33:952. [PMID: 22135788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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Abstract
BACKGROUND Leadership is not formally taught at any level in surgical training; there are no mandatory leadership courses or qualifications for trainees or specialists, and leadership performance is rarely evaluated within surgical appraisal or assessment programmes. METHODS Literature obtained from a MEDLINE search was reviewed to determine the characteristics of surgical leaders; outline an analytical framework through which these characteristics can be developed both in surgeons and surgical departments; and reflect on future challenges and recommendations for the central role of leadership in the field of surgery. RESULTS Leadership in surgery entails professionalism, technical competence, motivation, innovation, teamwork, communication skills, decision-making, business acumen, emotional competence, resilience and effective teaching. Leadership skills can be developed through experience, observation, and education using a framework including mentoring, coaching, networking, stretch assignments, action learning and feedback. CONCLUSION Modern surgery will need leaders with superior leadership skills that are well defined. It is vital that leadership programmes to develop leadership skills are put into practice in medical education curriculum and postgraduate surgical training. This will ensure maintenance and improvement in the quality of patient care.
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Affiliation(s)
- Vanash M Patel
- Department of Surgery and Cancer, Imperial College London, St Mary's Hospital, UK.
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Abstract
Thoraco-abdominal aortic aneurysm repair remains a formidable challenge to vascular surgeons. The traditional repair of thoraco-laparotomy with aortic cross-clamping is associated with a high morbidity and mortality despite significant advances in perioperative critical care, anaesthetic and surgical techniques. The advent of the endovascular revolution has shown a marked paradigm in the approach to all aneurysm repairs. As a logical progression from the open repair, the St Mary's visceral hybrid repair combines traditional open techniques (retrograde visceral and renal revascularisation via mid-line laparotomy) with endovascular stent grafting, thereby avoiding the need for thoracotomy and aortic cross-clamping. In specialist centres, the results have been encouraging and easily comparable to the open repair. The technique has been used in several centres around the world and represents a robust, transferrable method of repairing thoraco-abdominal aortic aneurysms. Stent-grafting technologies have reached a point of sophistication that wholly endovascular methods of repairing thoraco-abdominal aortic aneurysms are being performed in several centres around the world. Although these stent grafts have to be customised to the individual patient and are only suitable for certain types of aneurysmal anatomies, they represent the future of thoraco-abdominal aortic aneurysm repair. We review the history of thoraco-abdominal aortic aneurysm repair, the exciting advances in their treatment and discuss our approach to the management of thoraco-abdominal aortic aneurysms in the 21st century.
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Affiliation(s)
- A M T L Choong
- Department of Biosurgery and Surgical Technology, Division of Surgery, Oncology, Reproductive Biology and Anaesthetics, Imperial College London, UK.
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Kinross J, Warren O, Basson S, Holmes E, Silk D, Darzi A, Nicholson JK. Intestinal ischemia/reperfusion injury: defining the role of the gut microbiome. Biomark Med 2009; 3:175-92. [DOI: 10.2217/bmm.09.11] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Intestinal ischemia/reperfusion (I/R) injury initiates a systemic inflammatory response syndrome with a high associated mortality rate. Early diagnosis is essential for reducing surgical mortality, yet current clinical biomarkers are insufficient. Metabonomics is a novel strategy for studying intestinal I/R, which may be used as part of a systems approach for quantitatively analyzing the intestinal microbiome during gut injury. By deconvolving the mammalian–microbial symbiotic relationship systems biology thus has the potential for personalized risk stratification in patients exposed to intestinal I/R. This review describes the mechanism of intestinal I/R and explores the essential role of the intestinal microbiota in the initiation of systemic inflammatory response syndrome. Furthermore, it analyzes current and future approaches for elucidating the mechanism of this condition.
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Affiliation(s)
- James Kinross
- Department of Biomolecular Medicine, SORA, Imperial College London
| | - Oliver Warren
- Department of Biomolecular Medicine, SORA, Imperial College London
| | | | - Elaine Holmes
- Department of Biomolecular Medicine, SORA, Imperial College London
| | - David Silk
- Department of Biomolecular Medicine, SORA, Imperial College London
| | - Ara Darzi
- Department of Biomolecular Medicine, SORA, Imperial College London
| | - Jeremy K Nicholson
- Professor of Biological Chemistry, Head of Department of Biomolecular Medicine, SORA, Imperial College, 6th Floor, Sir Alexander Fleming Building, South Kensington Campus, London, SW7 2AZ, UK
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Panesar S, Chikwe J, Mirza S, Rahman M, Warren O, Rao C, Negus J, Zacharakis E, Darzi A, Athanasiou T. Off-Pump Coronary Artery Bypass Surgery May Reduce the Incidence of Stroke in Patients with Significant Left Main Stem Disease. Thorac Cardiovasc Surg 2008; 56:247-55. [PMID: 18615369 DOI: 10.1055/s-2008-1038514] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Leff DR, Leong JJH, Warren O, Athanasiou T, Yang GZ, Darzi A. Near-infrared spectroscopy: potential clinical benefits in surgery. J Am Coll Surg 2008; 206:761-2. [PMID: 18387486 DOI: 10.1016/j.jamcollsurg.2007.12.024] [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] [Received: 12/17/2007] [Accepted: 12/26/2007] [Indexed: 11/24/2022]
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Warren O, Darzi A, Athanasiou T. What is the Role of Leukocyte Depletion in Cardiac Surgery? Heart Lung Circ 2007; 16:398-9; author reply 399-400. [PMID: 17660043 DOI: 10.1016/j.hlc.2007.06.520] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2007] [Accepted: 06/13/2007] [Indexed: 11/21/2022]
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Kinross J, Warren O, Silk D, Darzi A. Perioperative synbiotic treatment to prevent postoperative infectious complications in biliary cancer surgery: a randomized control trial. Ann Surg 2007; 245:1000. [PMID: 17522529 PMCID: PMC1876952 DOI: 10.1097/sla.0b013e31805d0868] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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Warren O, Wallace S, Massey R, Tunnicliffe C, Alexiou C, Powell J, Meisuria N, Darzi A, Athanasiou T. Does Systemic Leukocyte Filtration Affect Perioperative Hemorrhage in Cardiac Surgery? A Systematic Review and Meta-Analysis. ASAIO J 2007; 53:514-21. [PMID: 17667241 DOI: 10.1097/mat.0b013e31805c15f9] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Cardiopulmonary bypass causes a systemic inflammatory reaction. Activation of leukocytes is an important part of this process, and is known to directly contribute to the development of postoperative coagulopathy, and thus hemorrhage. The removal of leukocytes from the cardiopulmonary bypass circulation, using specialized filters, has been proposed as one method for attenuating this inflammatory response. However, there is no consensus on its effectiveness. We used meta-analytical techniques to systematically assess the literature reporting on the potential effect of systemic leukofiltration on perioperative hemorrhage. Random effects modeling was used to calculate overall estimate, and heterogeneity was assessed. Systemic leukofiltration made no significant impact on chest tube drainage in the first 24 hours (weighted mean difference [WMD], x23.9 ml; 95% confidence interval [CI], x95.48-47.61; p = 0.51) or on the total packed red cell transfusion requirements of each patient (WMD, 7.84 ml; 95% CI, x80.13-95.81; p = 0.86). The studies performed in this area thus far are highly heterogeneous, due in part to relatively poor-quality design and inadequate matching of their study groups. Although further high-quality trials on systemic leukofiltration may be appropriate, other strategies to reduce the coagulopathy associated with cardiopulmonary bypass should be sought and evaluated.
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Affiliation(s)
- Oliver Warren
- Department of BioSurgery and Surgical Technology, Imperial College, St. Mary's Hospital, London, United Kingdom
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Darzi A, Warren O. Better: A surgeon’s notes on performance. J Clin Invest 2007. [DOI: 10.1172/jci32520] [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: 11/17/2022] Open
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Warren O, Alexiou C, Massey R, Leff D, Purkayastha S, Kinross J, Darzi A, Athanasiou T. The effects of various leukocyte filtration strategies in cardiac surgery. Eur J Cardiothorac Surg 2007; 31:665-76. [PMID: 17240156 DOI: 10.1016/j.ejcts.2006.12.034] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2006] [Revised: 11/16/2006] [Accepted: 12/23/2006] [Indexed: 11/16/2022] Open
Abstract
It is known that cardiopulmonary bypass causes an inflammatory reaction with an associated morbidity and mortality. Several anti-inflammatory strategies have been implemented to reduce this response, including leukocyte removal from the circulation using specialised filters. The aim of this study is to systematically review the available evidence on leukocyte filtration in cardiac surgery, focusing on its effect on systemic inflammation and whether this has influenced clinical outcomes. Five electronic databases were systematically searched for studies reporting the effect of leukocyte filtration at any point within the cardiopulmonary bypass circuit in humans. Reference lists of all identified studies were checked for any missing publications. Two authors independently extracted the data from the included studies. Whilst systemic leukodepleting filters do not appear to consistently lower leukocyte counts, they may preferentially remove activated leukocytes. Small improvements in early post-operative lung function in patients receiving systemic leukodepletion have been reported, but this does not lead to reduced hospital stay or decreased mortality. There is substantial evidence that cardioplegic leukocyte filtration attenuates the reperfusion injury at a cellular level, but this has not been translated into clinical improvements. Finally, whilst various strategies involving multiple leukocyte filters, or the incorporation of pharmacological agents into leukocyte-depleting protocols have been evaluated, the current available results are not conclusive. Our study suggests that there is not enough high quality or consistent evidence to draw guidelines regarding the use of leukocyte-depleting filters within routine cardiac surgical practice.
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Affiliation(s)
- Oliver Warren
- Department of BioSurgery and Surgical Technology, Imperial College, St Mary's Hospital, Praed Street, London, UK.
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Warren O, Mandal K, Hadjianastassiou V, Knowlton L, Panesar S, John K, Darzi A, Athanasiou T. Recombinant Activated Factor VII in Cardiac Surgery: A Systematic Review. Ann Thorac Surg 2007; 83:707-14. [PMID: 17258029 DOI: 10.1016/j.athoracsur.2006.10.033] [Citation(s) in RCA: 104] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2006] [Revised: 10/11/2006] [Accepted: 10/13/2006] [Indexed: 11/23/2022]
Abstract
Postoperative hemorrhage is a common complication in cardiac surgery, and it is associated with a considerable increase in morbidity, mortality, and cost. Recombinant activated factor VII (rFVIIa) is an emerging hemostatic agent, increasingly used in cardiac surgery. This article systematically reviews the evidence regarding the efficacy, safety, and cost of rFVIIa in this setting. Although definitive evidence from randomized controlled trials is lacking, the use of rFVIIa in patients experiencing refractory postoperative hemorrhage seems promising and relatively safe. However further research is required to definitively establish its clinical utility in the postoperative cardiac patient.
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Affiliation(s)
- Oliver Warren
- Department of BioSurgery and Surgical Technology, Imperial College Faculty of Medicine, St. Mary's Hospital, London, United Kingdom
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Abstract
Emergency laparoscopic surgery allows both the evaluation of acute abdominal pain and the treatment of many common acute abdominal disorders. This review critically evaluates the current evidence base for the use of laparoscopy, both diagnostic and interventional, in the emergency abdomen, and provides guidance for surgeons as to current best practise. Laparoscopic surgery is firmly established as the best intervention in acute appendicitis, acute cholecystitis and most gynaecological emergencies but requires further randomised controlled trials to definitively establish its role in other conditions.
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Affiliation(s)
- Oliver Warren
- Department of BioSurgery and Surgical Technology, Imperial College of Science, Technology and Medicine, St. Mary's Hospital, London, UK
| | - James Kinross
- Department of BioSurgery and Surgical Technology, Imperial College of Science, Technology and Medicine, St. Mary's Hospital, London, UK
| | - Paraskevas Paraskeva
- Department of BioSurgery and Surgical Technology, Imperial College of Science, Technology and Medicine, St. Mary's Hospital, London, UK
| | - Ara Darzi
- Department of BioSurgery and Surgical Technology, Imperial College of Science, Technology and Medicine, St. Mary's Hospital, London, UK
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Weerasinghe A, Athanasiou T, Philippidis P, Day J, Mandal K, Warren O, Anderson J, Taylor K. Platelet–monocyte pro-coagulant interactions in on-pump coronary surgery. Eur J Cardiothorac Surg 2006; 29:312-8. [PMID: 16423536 DOI: 10.1016/j.ejcts.2005.11.036] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2005] [Revised: 10/25/2005] [Accepted: 11/14/2005] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE Platelets and monocytes possess haemostatic properties, but the clinical effect of platelet-monocyte interactions on haemostasis following coronary surgery is not known. The study characterises the platelet and monocyte responses in cardiac surgery and its impact on haemostasis. METHODS In 1342 patients, changes in white blood cell counts (WBC), monocyte counts and platelet counts were measured. PMC formation was analysed by flow-cytometry using monoclonal antibodies against pan-leucocyte marker CD45, monocyte marker CD14 and platelet marker CD42. TF expression was determined using monoclonal antibodies against, CD45, CD14 and human-TF. Continuous variables were expressed as mean+/-SD. Changes in monocyte and platelet counts over time were considered as repeated measures data, and analysed using Generalised Estimating Equations (GEE). Multivariate regression analysis was used to evaluate the effect of several factors on blood loss. RESULTS A monocytosis occurs with on-pump coronary surgery, but is less pronounced than with off-pump surgery. No difference was seen in patients having redo-surgery or more complex cardiac surgery. Factors associated with monocytosis on multivariate analysis were higher body mass index (p=0.02), diabetes (p=0.035) and smoking (p=0.01). Older patients manifested a lower response (p<0.001). Cross-clamp fibrillation was associated with a lower (p=0.048) monocytic response than was cardioplegia. PMC formation dropped following administration of heparin, peaked at 5 min of CPB, and declined by 2h of CPB (p=0.04). A return towards preoperative levels was found during postoperative days 1-5. No significant change in monocyte TF expression occurred. The mean postoperative blood loss was 581.2+/-292.8 ml, and inversely related to increasing preoperative platelet counts (p<0.001), and to higher monocyte % counts (p=0.012). Patients, who were female (p<0.001), had higher body mass indices (p<0.001), and higher core body temperatures during surgery (p=0.013), as well as patients having perioperative aprotinin (p<0.001) related to less blood loss. CONCLUSIONS A higher postoperative platelet count as well as monocyte% significantly and independently decreases postoperative blood loss following cardiac surgery.
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Affiliation(s)
- Arjuna Weerasinghe
- Department of Cardiac Surgery, Imperial College School of Medicine, University of London, Hammersmith Hospital, Du Cane Road, London W12 0NN, UK.
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Warren O, Athanasiou T, Massey R, Hamady M, Stanbridge R. Large annular subvalvular left ventricular aneurysm: diagnostic evaluation using computed tomographic angiography. Tex Heart Inst J 2006; 33:529-31. [PMID: 17215989 PMCID: PMC1764974] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Affiliation(s)
- Oliver Warren
- Department of Cardiothoracic Surgery, St. Mary's Hospital, Imperial College, London, W2 1NY, United Kingdom.
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Aziz O, Athanasiou T, Panesar SS, Massey-Patel R, Warren O, Kinross J, Purkayastha S, Casula R, Glenville B, Darzi A. Does Minimally Invasive Vein Harvesting Technique Affect the Quality of the Conduit for Coronary Revascularization? Ann Thorac Surg 2005; 80:2407-14. [PMID: 16305930 DOI: 10.1016/j.athoracsur.2005.04.009] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2005] [Revised: 04/03/2005] [Accepted: 04/05/2005] [Indexed: 11/17/2022]
Abstract
The effect of minimally invasive great saphenous vein harvest on patient morbidity (wound infection and other healing disturbances) has been extensively investigated, yet its impact on the quality of the venous conduit is less well known. This study aims to review the literature with regard to macroscopic quality, postoperative myocardial infarction rates, and angiographic patency of the minimally invasive versus conventionally harvested vein using meta-analytic techniques where appropriate. Results suggest that conduits are comparable in macroscopic quality with minimally invasively harvested veins requiring more repairs prior to grafting. Postoperative myocardial infarction rates were not significantly different between groups, which is supported by the limited evidence on angiographic patency.
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Affiliation(s)
- Omer Aziz
- Department of Cardiothoracic Surgery, Imperial College of Science, Technology and Medicine, St. Mary's Hospital, London, United Kingdom
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Abstract
Cannabis smoking is on the increase both in the United Kingdom and in the United States. For over three decades it has been known that cannabis has pathophysiological effects on the cardiovascular system, and previously an association with an increased risk of myocardial infarction has been reported. However, it is not yet known whether cannabis contributes directly to coronary artery disease. We describe two distinct cases; in the first cannabis use precipitated a malignant arrhythmia in a patient with critical ischaemia from longstanding coronary artery disease. In the second, a young patient presented with an acute myocardial infarction that had started whilst smoking marijuana; subsequently diffuse coronary artery disease was found at angiography despite the patient's low risk factor status. Patients who are known cannabis smokers and who have cardiovascular disease should be warned that it is likely to aggravate coronary ischaemia, and may even trigger myocardial infarction.
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