Author: Jason Curtis

The robotic platform is the minimally invasive tool of choice- Improving techniques and outcomes (2024)

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Type of publication:

Conference abstract

Author(s):

Mohamedahmed A.; Abdalla H.E.; *Ismail A.; Yassin N.A.

Citation:

Colorectal Disease. Conference: 19th Scientific and Annual Conference of the European Society of Coloproctology, ESCP 2024. Thessaloniki Greece. 26(Supplement 2) (pp 239), 2024. Date of Publication: 01 Sep 2024.

Abstract:

Aim: This study aimed to assess the clinical outcomes of robotic compared with laparoscopic surgery within a transformation of minimally invasive total surgical practice. Method(s): A series of 201 consecutive patients relating to a single surgeon's experience when transforming total minimal invasive practice from laparoscopic to robotic surgery were included. Patients underwent laparoscopic and robotic surgery between 2018 and 2023. Short-term and long-term outcomes were evaluated and compared between the Laparoscopy (LG) and robotic (RG) with subgroup analyses according to procedure. Result(s): The median age and length of hospital stay (LOS) were 64 years and 6 days, respectively. Indications for surgery were CRC (62.2%), IBD (27.4%) and other general surgery conditions (hernia, appendicectomy, de-functioning loop colostomy, complex diverticular disease and rectal prolapse) (10.4%). The surgical approach was laparoscopic in 62 patients (30.8%) and Robotic in 139 patients (69.2%). Conversion to open was 12.9% in the LG versus 0% in the RG (p = 0.001). Regarding postoperative complications, the RG showed lower rate of overall complications [CD>=2 complications 14.3% in RG versus 16.1% in LG, p = 0.02], paralytic ileus [p = 0.03] and shorter LOS (p = 0.001) in comparison to LG. Moreover, both groups showed no difference in anastomosis leak [RG 1.3% vs LG 0%, p = 0.3], abdominal collection [RG 2.8% vs LG 2.5%, p = 0.5], re-operation [RG 1.4% vs LG 1.6%, p = 0.9], 30-day re-admission [RG 7.9% vs LG 8%, p = 0.9] and 30-day mortality [RG 0.7% vs LG 0%, p = 0.5]. Moreover, the RG remained superior when subgroup analyses were applied for anterior resection (39.3%), Right hemicolectomy (28.4%) and subtotal colectomy (13.4%). Conclusion(s): Robotic colorectal surgery improves clinical and surgical outcomes. This minimally invasive approach is the choice in a total transformation of practice from laparoscopic to robotic surgery, leading to significant reductions in LOS, rapid postoperative recovery, and an earlier return of gut function.

DOI: 10.1111/codi.17125

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Intravenous fluid mismanagement: time for national stewardship and quality improvement (2025)

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Type of publication:

Journal article

Author(s):

Breen, Andrew; *Miller, Ashley; Timmins, Alan; Barton, Greg; Kirk-Bayley, Justin; Peck, Marcus John Edwards; Davis, Huw John; Wilkinson, Jonathan.

Citation:

BMJ Open Quality. 14(4), 2025 Dec 14.

DOI: 10.1136/bmjoq-2025-003503

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The Impact of Smoking on Outcomes Following Anterior Cruciate Ligament Reconstruction: A Systematic Review and Meta-Analysis (2025)

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Type of publication:

Systematic Review

Author(s):

*Ibrahim, Abdelrahman; Al-Musabi, Musab; Kabariti, Rakan; Kempe-Gowda, Swarna; Wade, Roger.

Citation:

Cureus. 17(11):e96765, 2025 Nov.

Abstract:

The influence of smoking on postoperative outcomes following anterior cruciate ligament (ACL) reconstruction is a topic of ongoing scientific discussion and uncertainty. We aimed to conduct a systematic review and meta-analysis to compare the outcomes between smokers and non-smokers undergoing this procedure. We conducted a systematic search of electronic information sources, including MEDLINE, EMBASE, CINAHL, CENTRAL, ClinicalTrials.gov, and bibliographic reference lists. We applied a combination of free-text search and controlled vocabulary search adapted to thesaurus headings, search operators, and limits in each of the above-mentioned databases. Primary outcome parameters included surgical site infections, ACL graft rupture, revision rates, and patient-reported outcome measures (PROMs). We identified 24 comparative studies, including a total of 672,241 patients, of whom 69,113 were in the smoker group and 603,128 were in the non-smoker group. The analysis revealed that smoking was associated with a significantly higher risk of surgical site infections (OR 1.40, P=0.01). Smokers also reported significantly worse PROMs on the International Knee Documentation Committee (IKDC) score (MD -5.38, P<0.00001) and multiple Knee Injury and Osteoarthritis Outcome
Score (KOOS) subscales. There was no statistically significant difference between the two cohorts for ACL graft rupture or all-cause revision rates. Smoking appears to be associated with a higher risk of surgical site infections following ACL reconstruction and is linked to significantly poorer functional PROMs.

DOI: 10.7759/cureus.96765

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Factors associated with conversion from day-case to in-patient elective laparoscopic cholecystectomy surgery across England: an observational study using administrative data (2025)

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Type of publication:

Journal article

Author(s):

*Olagunju, Naomi; *Cheetham, Mark; Savage, Katrein; Briggs, Tim W R; Gray, William K.

Citation:

Surgical Endoscopy.  2025 Dec 18. [epub ahead of print]

Abstract:

PURPOSE: Elective laparoscopic cholecystectomy is increasingly being conducted as a day-case procedure. However, some patients planned for day-case surgery stay in hospital for at least one night. The aim of this study was to identify factors associated with conversion from planned day-case to in-patient management for elective laparoscopic cholecystectomy.

METHODS: This was an exploratory retrospective analysis of observational data from the Hospital Episode Statistics dataset for England. All patients aged >= 17 years undergoing a planned elective day-case laparoscopic cholecystectomy between 1st April 2017 and 31st March 2024 were identified. The exposure of interest was discharge on the day of admission (day-case) or requiring overnight stay. For reporting, providers were aggregated to an Integrated Care Board (ICB) level.

RESULTS: A total of 286,754 elective LCs planned as day-case were identified over the seven-year study period. Of these, 74,957 (26.1%) stayed in hospital for at least one night and were classed as day-case to in-patient stay conversions. In multilevel, multivariable modelling, conversion to in-patient stay was associated with great age (odds ratio (OR) 2.54 for 17-29 vs >= 70 years, p < 0.001), male sex (OR = 1.11, p < 0.001), deprivation (OR 1.14, first vs fifth quintile, p < 0.001), open surgery (46.93, p < 0.001), and low annual surgeon volume (OR 1.73, < 10 vs >= 80 LCs per year, p < 0.001). Comorbidities and post-procedural complications were also strongly associated with conversion. Across the 42 ICBs in England, model-adjusted conversion rates varied from 14.5% to 39.0%, 18 (42.9%) ICBs had conversion rates above the 99.8% control limit.

CONCLUSIONS: Conversion from day-case to in-patient stay was associated with increasing age, male sex, deprivation, open surgery, low surgeon volume, comorbidity and post-procedural complication. Our findings will help surgical team identify patients suitable for day-case laparoscopic cholecystectomy.

DOI: 10.1007/s00464-025-12480-z

Facing the isles: Maxillofacial emergencies unveiled - A tale of two realms (2024)

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Type of publication:

Conference abstract

Author(s):

*Kichenaradjou A.; Reddy M.; *Shah N.

Citation:

Craniomaxillofacial Trauma and Reconstruction. Conference: FACE AHEAD 2024. Prague Czechia. 17(1 Supplement) (pp 80S-81S), 2024. Date of Publication: 01 Jun 2024.

Abstract:

The Noble hospital on the Isle of Man likely experiences a lower volume of maxillofacial emergencies compared to district general hospitals in mainland UK. The Island's smaller population and relative tranquillity contributes to this. Common maxillofacial emergencies include facial trauma, dental infections and oral abscesses. In contrast, district general hospitals in mainland UK, like those in Shrewsbury and Telford hospitals, likely to handle a higher volume and variety of maxillofacial emergencies due to their larger catchment areas and higher population density. We audit and present the emergency work undertaken during the year 2023 between Noble hospital and the district general hospital(s) of the Shrewsbury and Telford hospitals NHS.

DOI: 10.1177/19433875241232784

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Utilising research management technology to streamline and integrate pharmacy clinical trial processes within a multi-disciplinary research team: a service evaluation (2025)

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Type of publication:

Conference abstract

Author(s):

*Essra Y.; *Angela Y.; *Rachel R.;

Citation:

International Journal of Pharmacy Practice. Conference: Royal Pharmaceutical Society Annual Conference, RPS 2025. London United Kingdom. 33(Supplement 1) (pp i17), 2025. Date of Publication: 01 Nov 2025

Abstract:

Introduction: Clinical trials are the gold standard for testing pharmacological, behavioural and policy interventions [1]. In hospital settings, trial setup can be complex, requiring coordination across multiple teams, specialties, and environments. For trials involving InvestigationalMedicinal Products (IMPs), pharmacy departments must align their processes with other research teams in a transparent, efficient, and standardised manner [2]. One approach to achieving this is using a research management system. Aim(s): To evaluate the implementation of a digital research management system (EDGE) in streamlining and standardising the setup of clinical trials involving pharmacy and other departments. Methodology: As this was a service evaluation, ethical approval was not required. Retrospective quantitative data from between 01 May 2022- 28 May 2025 were extracted from the research management system at a single NHS hospital trust. Data were analysed to assess the number of pharmacy workflows set up, turnaround times and the range of clinical trials supported. Qualitative stakeholder feedback on experiences of implementation were also sought from research nurse colleagues and the trust governance and quality assurance lead. Result(s): Between 2022-2025, four pharmacy-specific workflows were developed and implemented. These were: Expression of interest/feasibility; Amendment implementation; Pharmacy site file audit and Trial closure and archiving. A total of 161 workflows were completed across 62 different clinical trials. Notably 67% of pharmacy workflows were completed ahead of their target timelines. Feedback from research nurses and the trust research and governance lead was positive. The implementation of the pharmacy workflows provided greater transparency for pharmacy set-up and management of clinical trials facilitating better collaborative relationships between the team. Use of the workflows also lead to reduction in e-mail correspondence with better ability to track progress with different tasks and provide visibility to obstacles and blockers. Discussion(s): The implementation of a research management system significantly improved the efficiency, transparency, and coordination of pharmacy workflows in clinical trial setup and management. Positive stakeholder feedback and early completion of most workflows suggest that digital tools can enhance interdisciplinary collaboration in research settings. A key limitation is this evaluation was limited to a single NHS trust and relied on retrospective data and informal stakeholder feedback, which may not fully capture the broader impact or generalisability of the findings.

DOI: 10.1093/ijpp/riaf093.092

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Double jeopardy: Escalating mortality trends and disparities in lung cancer patients with sepsis - A retrospective epidemiological study (2025)

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Type of publication:

Conference abstract

Author(s):

Hemida M.F.; Sarfraz M.R.; Khan T.; Mushtaq I.; Ibrahim A.A.; Chandak V.; Al-Saadi M.; Sharhiar Z.; *Ali A.

Citation:

Thorax. Conference: British Thoracic Society Winter Meeting 2025. Westminster . 80(Supplement 2) (pp A249-A250), 2025. Date of Publication: 01 Nov 2025

Abstract:

Background Lung cancer (LC) remains the leading cause of cancer-related mortality globally. Studies indicate LC patients with sepsis have significantly lower survival rates, yet the temporal trends and disparities in mortality remain unexplored. We examined mortality trends and disparities of LC complicated by sepsis across different sociodemographic strata. Methods This retrospective study analysed death certificate data from the Centers for Disease Control and Prevention's Wide-Ranging Online Data for Epidemiologic Research database from 1999-2023, for individuals >=25 years with multiple causes of death listed as lung/bronchus cancer (ICD-10: C34) with sepsis. Age-adjusted mortality rates (AAMRs) per 100,000 population were calculated and stratified by sex, race/ethnicity, and geographic region, with Joinpoint regression analysis to determine the change in mortality trends. Results From 1999-2023, 103,907 deaths were attributed to LC with co-existing sepsis, demonstrating increasing mortality trends throughout the study period. AAMRs rose significantly from 1.61 in 1999 to 2.07 in 2023 (AAPC: 1.32%; p<0.000001). Sex-stratified analysis revealed men had consistently higher overall AAMRs (2.32/100,000) with an AAPC of 0.49% (95% CI: -0.12 to 1.12; p=0.12) compared to women (1.37/100,000) with an AAPC of 1.94% (95% CI: 1.74 to 2.14; p<0.000001). Patients aged >=65 years exhibited the highest mortality rates (6.59%). Racially, non-Hispanic (NH) Black individuals had the highest overall AAMRs with increasing mortality patterns (AAMRs: 2.57/100,000; AAPC: 0.32%; 95% CI: 0.045 to 0.599; p=0.02), while Hispanic populations recorded the lowest AAMR (1.01/100,000; AAPC: 0.61%; 95% CI: 0.156 to 1.068; p=0.01). Regionally, the South demonstrated the highest mortality (AAMRs: 2.04), followed by the Northeast (AAMRs: 1.78), Midwest (AAMRs: 1.75), and West (AAMRs: 1.42). Most deaths occurred in inpatient medical facilities (90,425 deaths; 87%). Conclusion Mortality rates increased significantly over the study period with a significant increase during recent years. Notable disparities across sex, race/ethnicity, and geographic regions were observed, with NH Black populations and Southern states showed highest mortality rates. These findings highlight the urgent need for targeted sepsis prevention protocols in LC patients, enhanced surveillance systems for high-risk demographics, and comprehensive region-specific interventions to address underlying healthcare disparities and improve clinical outcomes across all populations.

DOI: 10.1136/thorax-2025-BTSabstracts.358

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Epidemiology of cystic fibrosis-related deaths in the united states, 1999-2023: A CDC WONDER-based study (2025)

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Type of publication:

Conference abstract

Author(s):

Mushtaq I.; Sarfraz M.R.; Hemida M.F.; *Ali A.; Ibrahim A.A.; Patel K.; Saghir M.; Sharhiar Z.; Ahmad H.M.; Chaudhry Z.J.

Citation:

Thorax. Conference: British Thoracic Society Winter Meeting 2025. Westminster . 80(Supplement 2) (pp A55-A56), 2025. Date of Publication: 01 Nov 2025.

Abstract:

Background Cystic fibrosis (CF) is a hereditary multisystem disorder predominantly affecting the respiratory system, contributing significantly to morbidity and mortality in the developed nations, despite advancement in treatments. Characterizing mortality patterns across demographic and geographic populations is essential for developing targeted prevention and management strategies. Therefore, we analyzed temporal mortality trends in cystic fibrosis across diverse populations in the United States from 1999-2023. Methods Data were extracted from the CDC WONDER database (1999-2023) to identify mortality rates among individuals aged >=1 year with CF listed as the underlying cause of death (ICD-10: E84.0, E84.1, E84.8, E84.9). Age-adjusted mortality rates (AAMRs) per 100,000 population were calculated and stratified by sex, age group, race/ethnicity, geographic region, and place of death. Temporal trends were analyzed using Joinpoint regression to estimate average annual percent change (AAPC). Results From 1999-2023, 11,997 deaths were reported among individuals with CF across all age groups (<1 to >=65 years). The AAMR decreased significantly from 0.19 in 1999 to 0.09 in 2023 (AAPC: -3.1%; p<0.000001), with accelerated decline in recent years. Both sexes demonstrated comparable average AAMRs (0.15), though with different rates of decline: men (AAPC: -2.7%; 95% CI: -4.17 to -1.29; p=0.0002) and women (AAPC: -2.9%; 95% CI: -4.19 to -1.66; p=0.000008). By race/ethnicity, non-Hispanic populations exhibited higher overall AAMRs compared to Hispanics (0.18 vs. 0.06), with incongruent trends observed among non-white races and Hispanic populations. Regionally, the Midwest recorded the highest AAMR (0.17), followed by the South (0.16), Northeast (0.15), and West (0.13). Age-stratified analysis revealed peak mortality in the 15-34 years group (0.32/100,000), followed by the 35-64 years group (0.12/100,000). Most deaths occurred in inpatient medical facilities (8,260 deaths; 68.8%). Conclusion CF mortality rates declined significantly over two decades, with comparable reductions in both sexes. However, substantial disparities persist, with young adults (15-34 years) experiencing high mortality rates and notable racial/ethnic differences. Regional disparities were evident across geographic areas. While these findings suggest improved CF management and care, they underscore the critical need for targeted interventions addressing persistent demographic and geographic disparities to ensure equitable outcomes across all populations.

DOI: 10.1136/thorax-2025-BTSabstracts.79

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Eosinophilic phenotype and bacterial load in hospitalised patients with exacerbations of COPD (2025)

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Type of publication:

Conference abstract

Author(s):

*Thumbe A.; *Ahmad N.

Citation:

Thorax. Conference: British Thoracic Society Winter Meeting 2025. Westminster . 80(Supplement 2) (pp A122), 2025. Date of Publication: 01 Nov 2025.

Abstract:

Background COPD is a heterogenous disease, and the eosinophilic phenotype is now well recognised as a treatable trait. However, it is less well known as to what extent bacterial infections affect this group of patients.1 Aim Our primary aim was to look at the incidence of bacterial growth in eosinophilic and the non-eosinophilic phenotype within our cohort of patients with COPD. Method A retrospective analysis was conducted on patients coded has having been admitted to our Trust with COPD exacerbations from October 2020 to April 2021. Historic sputum culture results were collected from our web-based patient portal. Patients were included in the analysis if they had a sputum culture showing bacterial growth at any time. Eosinophilic phenotypes (EP) were defined as having a blood eosinophil count >=0.3×109/L and non-eosinophilic phenotypes (NEP) as having a blood eosinophil count<0.3×109/L. Results In the study period, 337 unique patients were admitted with COPD exacerbations. They had a mean age (SD) of 73 (9) years, 49.6% (167/337) were female and 64.1% (216/337) were EP. 47% (n=157/337) patients had at least one positive sputum culture. Of these, 68.8% (n=108/157) were classified as EP. 72%(n=108/150) of EP had a positive sputum culture compared to 70% (n=49/70) of NEP; Odds Ratio 1.10 (95% CI 0.59-2.06); Chi-Square 0.021; p=0.88. When compared, NEP had higher burden of H. Influenzae, Strep Pneumoniae and Moraxella (59%, 20% and 20% vs 55%, 19% and 15%, respectively) whereas EP had a higher burden of Coliforms, Pseudomonas sp and S.aureus (32%, 30% and 15% v 25%, 25% and 8%, respectively). Conclusion Our findings suggest that in COPD patients requiring hospital admission, there is no significant difference between the bacterial burden of EP and NEP. Hence, future treatments of EP should not only include biologics but also focus on the role of bacteria in preventing exacerbations.

DOI: 10.1136/thorax-2025-BTSabstracts.179

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Two decades, two destinies: When chronic obstructive pulmonary disease hearts beat differently - The divergent mortality trajectories of atrial fibrillation vs other arrhythmias (2025)

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Type of publication:

Conference abstract

Author(s):

Sarfraz M.R.; Hemida M.F.; *Ali A.; Ishtiaq S.; Patel K.; Hussein M.; Tabasum P.; Basit Kayani A.; Mehmood H.; Mushtaq I.; Rehman S.;

Citation:

Thorax. Conference: British Thoracic Society Winter Meeting 2025. Westminster . 80(Supplement 2) (pp A71-A73), 2025. Date of Publication: 01 Nov 2025.

Abstract:

Background While arrhythmias are recognized as potential causes of death in chronic obstructive pulmonary disease (COPD) patients. However, temporal trends in arrhythmia-related mortality among COPD patients remain unexamined. Therefore, we conducted a comparative study evaluating mortality trends between atrial fibrillation (AF) and other arrhythmias in COPD patients. Methods A retrospective analysis of was conducted from 1999-2023, using the CDC WONDER database comparing COPD patients with AF (ICD-10: I48) versus other arrhythmias (ICD-10: I47, I49). Age-adjusted mortality rates (AAMRs) per 100,000 population were stratified by demographic variables for adults >=25 years. Joinpoint regression estimated average annual percent changes (AAPC) in mortality trends. Results From 1999-2023, 537,088 COPD-AF deaths were recorded (280,378 Men; 256,710 Women). AAMRs increased significantly from 5.55 to 13.66 (AAPC: +3.87%). Conversely, 168,770 COPD patients with other arrhythmias died (96,472 Men; 72,298 Women), with AAMRs declining significantly from 5.19 to 2.04 (AAPC: -3.56%). Men consistently showed higher mortality rates in both COPD with AF and other arrhythmias. In COPD-AF, AAMRs increased significantly for both genders (p<0.000001): men (7.96 to 16.95; AAPC: +3.23%) and women (4.17 to 11.19; AAPC: +4.18%). Conversely, in the COPD with other arrhythmias cohort, mortality rates decreased significantly (p<0.000001) for both men (AAMR: 7.68 to 2.67; AAPC: -4.05%) and women (AAMR: 3.58 to 1.52; AAPC: -3.16%). Inpatient medical facilities were the most common place of death for both groups, though COPD-AF patients had fewer inpatient deaths (59,284) than those with other arrhythmias (190,982). Both cohorts showed a notable shift toward increased home deaths over the study period. Racially, Whites had the highest AAMRs in both groups (AF: 11.04; other: 3.32), followed by American Indians (AF: 8.18; other: 2.78). Regionally, the Midwest showed highest mortality with opposing trends: upward for AF (AAPC: +4.89%) and downward for other arrhythmias (AAPC: -3.30%) p<0.000001. At state level, Vermont had the highest COPD-AF mortality (AAMR: 16.33), while Ohio had the highest AAMR for other arrhythmias (5.20). Conclusion COPD-AF mortality increased dramatically while other arrhythmia mortality declined significantly. Men showed consistently higher mortality with notable demographic disparities. These opposing trends suggest AF represents an emerging threat requiring targeted interventions.

DOI: 10.1136/thorax-2025-BTSabstracts.104

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